Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans

• Published in: The American journal of surgery 2011-06, Vol.201 (6), p.789-796
• Main Authors: Kuy, SreyRam, M.D., M.H.S, Sosa, Julie Ann, M.D., M.A, Roman, Sanziana A., M.D, Desai, Rani, Ph.D, Rosenthal, Ronnie A., M.D
• Format: Article
• Language: English
• Subjects: Adults; Age; Age factors; Aged; Aged, 80 and over; Bile; Biological and medical sciences; Cholecystectomy; Cholecystectomy - economics; Comorbidity; Complications; Cost of Illness; Cross-Sectional Studies; Disease; Elderly patients; Female; Follow-Up Studies; Gallbladder diseases; Gallbladder Diseases - economics; Gallbladder Diseases - mortality; Gallbladder Diseases - surgery; Gallstones; General aspects; Geriatrics; Health care; Health care expenditures; Hospital Mortality - trends; Humans; Laparoscopy; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Miscellaneous; Mortality; Older people; Outcomes; Patients; Population; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression analysis; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate - trends; United States - epidemiology; Variables
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2010.04.018

Abstract Background Gallstone disease increases with age. The aims of this study were to measure short-term outcomes from cholecystectomy in hospitalized elderly patients, assess the effect of age, and identify predictors of outcomes. Methods This was a cross-sectional analysis, using the Health Care Utilization Project Nationwide Inpatient Sample (1999–2006), of elderly patients (aged 65–79 and ≥80 years) and a comparison group (aged 50–64 years) hospitalized for cholecystectomy. Linear and logistic regression models were used to evaluate age and outcome relationships. Main outcomes were in-hospital mortality, complications, discharge disposition, mean length of stay, and cost. Results A total of 149,855 patients aged 65 to 79 years, 62,561 patients aged ≥ 80 years, and 145,675 subjects aged 50 to 64 years were included. Elderly patients had multiple biliary diagnoses and longer times to surgery from admission and underwent more open procedures. Patients aged 65 to 79 years and those aged ≥80 years had higher adjusted odds of mortality (odds ratios [ORs], 2.36 and 5.91, respectively), complications (ORs, 1.57 and 2.39), nonroutine discharge (ORs, 3.02 and 10.76), longer length of stay (ORs, 1.11 and 1.31), and higher cost (ORs, 1.09 and 1.22) than younger patients. Conclusions Elderly patients undergoing inpatient cholecystectomy have complex disease, with worse outcomes. Longer time from admission to surgery predicts poor outcome.