Laparoscopic cholecystectomy for acute cholecystitis in the elderly: is it safe?
BACKGROUND
The purpose of this study was to evaluate the outcome of laparoscopic cholecystectomy (LC) in patients with acute cholecystitis aged 75 years and older.


METHODS
A retrospective chart review was performed on the 1216 cholecystectomies performed in our department from 2000 to 2005. A total of 225 patients underwent attempted LC for acute cholecystitis, of whom 42 were more than 75 years old and 183 younger.


RESULTS
There was no difference in mean duration of symptoms before admission and length of hospital stay before surgery (3.8 d in elderly vs. 3.1 in younger patients, and 2.8 vs. 2.3 d, respectively). In all, 21% of the elderly patients had American Society of Anesthesiologists score III and IV. Mean operative time and conversion rate to open surgery were similar in both groups. Postoperative stay was longer in elderly (3.9 vs. 2.8). The postoperative complications rate and mortality were significantly higher in the elderly group (31% vs. 15%, and 4.8% vs. 0.5%, respectively).


CONCLUSIONS
LC in elderly patients suffering from acute cholecystitis is feasible and effective. It is associated with a higher rate of morbidity unrelated to the surgical site and mortality in elderly compared with younger patients. Stronger selection of elderly patients for surgery is needed.
Kirshtein
Boris
B
Department of Surgery "A" Soroka Medical Center, Department of Epidemiology, Ben-Gurion University of the Negev, Beer Sheva, Israel. borkirsh@bgu.ac.il
Bayme
Michael
M
Bolotin
Arkady
A
Mizrahi
Solly
S
Lantsberg
Leonid
L
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D041881:Cholecystitis, Acute / Q000150:complications / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome