[Choice of therapeutic approach in acute cholecystitis in the elderly].
BACKGROUND
Acute cholecystitis in elderly patients is a common disease characterized by a high mortality rate and serious complications.


OBJECTIVE
To compare conservative vs. surgical therapy for acute cholecystitis in the elderly.


METHODS
This is a retrospective study including patients 70 years-old or older with the diagnosis of acute cholecystitis (AC) treated between 2003 and 2009. Epidemiological and clinical data, diagnostic approach, surgical variables and cost-effectiveness were analyzed. According to the first therapeutic intent, the analysis was performed among final treatment groups and among older than 80 years and younger cases. p < 0.05 was considered significant. Statistical analysis was performed with StatView(©) 5.0.


RESULTS
During the six-year period 173 episodes of acute cholecystitis were treated on 147 patients (52% females), with a mean age of 80.6 years (range 70-101). In 103 cases medical treatment was taken, with 82 cases of resolution of the clinical picture, 15 unexpected operations and 6 deceases. Other 70 cases were undergone surgery as first option, 78.5% of them through laparoscopy with a conversion rate of 19.7%.


CONCLUSIONS
In our study, surgery and medical treatment get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy. We recommend performing emergency surgery in high-risk elderly patients rather than conservative therapy due to a tendency to increase morbidity with later approach.
Sánchez-Beorlegui
J
J
Servicio de Cirugía General y Digestiva, Fundación Hospital de Calahorra, La Rioja, España. js_beorlegui@hotmail.com
Lamata-Hernández
F
F
Lagunas-Lostao
E
E
Monsalve-Laguna
E C
EC
Peñalva-Segura
P
P
D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000601:surgery / Q000628:therapy*; D003663:Decision Trees; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies