D. J. Li1, M. Terjimanian1, L. M. Napolitano1, M. Englesbe2, D. A. Campbell2, K. B. To1 1University Of Michigan,Acute Care Surgery / Dept Of Surgery,Ann Arbor, MI, USA 2University Of Michigan,Dept Of Surgery,Ann Arbor, MI, USA
Introduction:
Laparoscopic cholecystectomy (LC) is the procedure of choice for treatment of cholelithiasis/cholecystitis, and carries a lower risk for morbidity and mortality when compared to open cholecystectomy (OC). Likewise, elective/semi-elective cholecystectomy (EL) carries a lower complication rate than emergency cholecystectomy (EM). When assessing risk across age groups, there is limited data regarding complication and mortality risk for older patients. We hypothesize that while there will be an expected difference in older patients, the difference will be greater for emergency operations in older patients, and especially so for those undergoing open cholecystectomy.
Methods:
Prospective data were obtained from a state-wide Surgical Quality Collaborative (SQC) database with a random sample of 20-30% of all surgeries performed 1/1/2005-12/31/2010. Patient characteristics, preoperative comorbidities, complication and mortality rates were compared for emergent and elective cases. Patient outcomes were stratified according to age groups: (1) age <45years; (2) age 45-64 years; (3) age 65-79 years; and (4) age >80 years
Results:
Over the 5-year time period, 18106 cholecystectomies were logged into the SQC database. A total of 1409 cases were classified as emergency operations, of which 1080 were completed laparoscopically and 329 were completed open. A total of 16697 patients in the database underwent elective operations, of which 15185 were laparoscopic and 1512 were open. Overall, 71.5% of patients were female, with a mean age of 49.9 years. Overall morbidity was 2.2% for elective LC, 14.6% for elective OC, 3.7% for emergent LC and and 24% for emergent OC cases. Patient data as stratified by age groups are listed in Table 1. The difference in outcome between age groups 3&4 in the emergent setting is much greater than the difference between the same age groups in the elective setting (P<0.001).
Conclusion:
Patient who are >80 years of age have significant risk for morbidity and mortality in both elective and emergency cholecystectomies. This increase in risk overall, the difference is much higher in the emergent population, regardless of surgical approach. This demonstrates a need for closer analysis for improvement in the care of elderly patients undergoing cholecystectomy, especially in the emergent setting.
