How Safe is Performing Cholecystectomy in the Oldest Old? A 15-year Retrospective Study from a Single Institution

• Published in: World journal of surgery 2018-01, Vol.42 (1), p.73-81
• Main Authors: Novello, Matteo, Gori, Davide, Di Saverio, Salomone, Bianchin, Matteo, Maestri, Lorenzo, Mandarino, Francesco Vito, Cavallari, Giuseppe, Nardo, Bruno
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Bile ducts; Cardiac Surgery; Charts; Cholecystectomy; Cholecystitis; Data processing; Demographics; Demography; Disease control; Emergency management; Emergency preparedness; Feasibility studies; Gallbladder; General Surgery; Laparoscopy; Medicine; Medicine & Public Health; Mortality; Nonagenarian; Original Scientific Report; Regression analysis; Risk factors; Safety; Statistical analysis; Surgery; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-017-4147-8

Background Globally, the number of people aged 80 years or over, the “oldest old,” is the fastest growing population group. Because of the strong association between age and gallstone disease, both prevalence and incidence of this disease are increasing. The feasibility of the cholecystectomy in octogenarians has been evaluated in several studies that confirmed the safety of the operation. However, the safety of this procedure in nonagenarians is still controversial. The aim of this study was to evaluate the safety of cholecystectomies in nonagenarians and identify related predictors for postoperative hospital length of stay (LOS) and in-hospital mortality up to 30 days postoperatively. Methods More than 500 cholecystectomies, both open and laparoscopic, were performed between January 2000 and September 2015 at our institution in patients 80 years and older. These statistics include both elective and emergent admissions. A retrospective review of charts over the last 15 years was conducted to compare mortality and length of postoperative stay among two patient groups: 319 octogenarians and 36 nonagenarians. Parameters evaluated include demographics, surgical presentation, American Society of Anesthesiologists (ASA) score, main diagnosis, comorbidities, type of surgery performed, LOS and in-hospital mortality. All data were analyzed with STATA (v.13) software, using a multivariate logistic regression after determining the statistically significant variables through a stepwise regression. Conclusions We found out that being nonagenarian, compared to octogenarian, is not a significant risk factor in terms of LOS and in-hospital mortality within 30 days postoperatively. Despite that, the mortality rate among nonagenarians is still remarkably high as almost every patient was admitted in an emergent setting. The most remarkable predictor for mortality among the two groups was an “afternoon/night emergency” surgical presentation (OR 25.5, CI 1.53–42.35, p  = 0.02). Thus, the surgical emergency management for gallbladder disease at our institution should be critically reevaluated. Performing the procedure in laparoscopy predicted a significant reduction (−5 days, CI −8.5 to −1.4, p  = 0.006) of LOS, while presenting with “gallbladder and bile duct stones” (+6.3 days, CI 1.5–11.1, p  = 0.01) or “acalculous cholecystitis” (+4.7 days, CI 0.4–9.2, p  = 0.03) had the opposite effect. Despite the remarkable mortality rate of our series, being nonagenarian should not be