Advantages of laparoscopic cholecystectomy in the elderly and in patients with high ASA classifications.
Two hundred and thirty-three patients underwent cholecystectomy at Mercy Hospital of Pittsburgh during the popularization of laparoscopic cholecystectomy. Laparoscopic cholecystectomy was performed in 167 of these patients while the remaining 66 patients had an open cholecystectomy. A statistically significant increase in the incidence of morbidity was observed with advancing age (p < 0.001, odds ratio 2.33) as well as in patients with higher ASA classes (p < 0.001, odds ratio 2.31). Overall, laparoscopic cholecystectomy was associated with a markedly lower incidence of morbidity than the open procedure (7% versus 47%, p < 0.001). A multiple logistic regression model was applied to the study population due to the fact that those patients who underwent open cholecystectomy tended to be older individuals with more clinically significant associated medical conditions than those individuals who underwent the laparoscopic procedure. When the logistic regression model was applied to control for the differences in age, associated illnesses, and ASA class between the two groups; a seven fold increase in the risk of morbidity was found in the open group as compared to the laparoscopic group (p < 0.001, odds ratio 7.31). These findings favor the use of laparoscopic cholecystectomy over open cholecystectomy in all eligible patients, especially elderly patients and those patients in higher ASA classes.
Massie
M T
MT
Department of Surgery, Mercy Hospital of Pittsburgh, PA.
Massie
L B
LB
Marrangoni
A G
AG
D'Amico
F J
FJ
Sell
H W
HW
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D002764:Cholecystitis / Q000601:surgery; D002769:Cholelithiasis / Q000601:surgery; D003324:Coronary Artery Disease / Q000150:complications; D003365:Costs and Cost Analysis; D004194:Disease / Q000145:classification; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D001261:Pulmonary Atelectasis / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome