title: Laparoscopic cholecystectomy in the elderly: increased operative complications and conversions to laparotomy.
abstract: BACKGROUND
  The incidence of gallstones increases with age and as the proportion of the population 65 years of age and older continues to grow, increased demand for laparoscopic cholecystectomy (LC) in the geriatric population is likely. LC has advantages over open cholecystectomy, but comparative evaluation of the procedure in elderly patients is lacking.
  
  
  METHODS
  We performed a two-year review of patients undergoing LC at our institution. Demographic information, diagnosis, operation performed, and operative complications were recorded. Patients were placed into two groups by age: 65 years and older, and those younger than 65 years of age. Primary outcome measures were complication rate and conversions to laparotomy.
  
  
  RESULTS
  A total of 315 patients underwent LC during the study period, of whom 59 (19%) were 65 years of age or older. The older age group experienced higher rates of conversion to an open procedure (22% vs. 2.7%, P<0.05), and operative complications (17% vs. 3.1%, P<0.05). Elderly patients also had longer operative times (108+/-55 minutes vs. 83<34 minutes, P<0.05). Acute (31% vs. 16%) and chronic (14% vs. 7.4%) cholecystitis were the operative diagnoses in a greater proportion of patients in the older age group, and elderly patients were more likely to have had prior upper abdominal surgery (8.5% vs. 1.6%, P<0.05).
  
  
  CONCLUSIONS
  LC in the geriatric population carries increased risk for conversion to laparotomy and operative complications compared to LC in younger patients. This is likely due to increased acuity and chronic right upper quadrant inflammation in this population. Surgeons should bear these issues in mind in the counseling and care of these patients.
authors.affiliation: Department of General Surgery, Brooke Army Medical Center, Fort Sam, Houston, Texas 78234, USA. david.kauvar@amedd.army.mil
authors.forename: David S
authors.initials: DS
authors.lastname: Kauvar
authors.forename: Brandon D
authors.initials: BD
authors.lastname: Brown
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Braswell
authors.forename: Michael
authors.initials: M
authors.lastname: Harnisch
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome