ORIGINAL ARTICLE   

Minerva Chirurgica 2019 August;74(4):289-96

DOI: 10.23736/S0026-4733.19.07891-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Cholecystectomy for acute cholecystitis in octogenarians: impact of advanced age on postoperative outcome

Samuele VACCARI ¹ ✉, Augusto LAURO ¹, Maurizio CERVELLERA ¹, Giorgio PALAZZINI ², Giovanni CASELLA ², Alberto SANTORO ², Domenico MASCAGNI ², Pietro URSI ², Eliana GULOTTA ³, Umberto D'ERRICO ¹, Alessandro USSIA ¹, Niccolò DE SIENA ¹, Stefania BIANCHINI ¹, Vito D'ANDREA ², Valeria TONINI ¹

¹ Unit of Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum University, Bologna, Italy; ² “Advanced Surgical Technologies” Department of Surgical Sciences, Umberto I University Hospital, La Sapienza University, Rome, Italy; ³ Unit of Plastic Surgery and Burn Care, Arnas Civico Hospital, Palermo, Italy

BACKGROUND: The number of surgical operations in elderly patients is increasing due to the aging demographics of western populations. The aim of the present study was to investigate the peri-operative outcome of octogenarian patients undergoing cholecystectomy for acute cholecystitis.
METHODS: We performed a retrospective analysis including all patients who underwent cholecystectomy for acute cholecystitis from January 2013 to December 2017. Records were collected prospectively from two centers: 1) Unit of Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum University, Bologna; 2) “Advanced Surgical Technologies” Department of Surgical Sciences, Umberto I University Hospital, La Sapienza University, Rome. Patients were divided by age (≥ or <80 years) and peri-operative outcomes were compared.
RESULTS: During the study period, 464 patients were operated for acute cholecystitis in the two centers. Sixty-three (14%) patients were octogenarians (group 1) and median age was 84.8±3.9 years. Four hundred and one patients (86%) were younger than 80 years (group 2) with median age of 55.3±15.3 years. Forty-four per cent of group-1 patients underwent laparoscopic cholecystectomy versus 81% of the younger group (P<0.01). Elderly patients had a higher percentage of overall complications (25% vs. 9%; P=0.03) and a longer median postoperative length of stay (7.2±6.8 vs. 4.6±7.7; P=0.04). Overall mortality was 1%: two patients died in group-1 and one in group-2 (P=0.50). However, on multivariate analysis age older than 80 years was not found to be an independent risk factor for postoperative morbidity and mortality.
CONCLUSIONS: The results of this study suggest that cholecystectomy for acute cholecystitis in octogenarians is a relatively safe procedure with an acceptable risk of complications and a postoperative hospital stay comparable to younger ones.

KEY WORDS: Cholecystectomy; Cholecystitis, acute; Aged, 80 and over