title: Changing approaches to cholecystectomy in elderly patients: a 10-year retrospective study in Taiwan.
abstract: BACKGROUND
  The prevalence of symptomatic gallbladder diseases increases with age. The present study evaluated cholecystectomy risk factors and hospital resource utilization in an elderly (aged 60 years and older) population of patients who had undergone open cholecystectomy (OC) or laparoscopic cholecystectomy (LC).
  
  
  METHODS
  The study analyzed 20,538 OC and 29,318 LC procedures performed in Taiwan from 1996 to 2007. Odds ratio (OR) and 95% confidence interval were calculated to assess the relative change rate. Regression models were employed to predict length of stay (LOS) and total surgical cost.
  
  
  RESULTS
  Patient characteristics associated with increased likelihood of undergoing LC were age 60-69 years, female gender, and lack of current co-morbidities. Length of stay associated with both OC and LC decreased during the study period. Total surgical cost for elderly OC patients increased during the study period, whereas that for elderly LC patients declined. Compared to OC patients, LC patients had significantly larger changes in LOS (-2.27 days) and total surgical cost ($ -368.64 U.S. dollars) (p < 0.001). The following factors were associated with considerable increases in both LOS and total surgical cost: advanced age, female gender, presence of one or more co-morbidities, treatment in a regional or a district hospital, and long LOS.
  
  
  CONCLUSIONS
  Decreases in hospital resource utilization were larger in elderly LC patients than in elderly OC patients. Health care providers and patients should observe that hospital resource utilization may depend on hospital attributes as well as patient attributes. These analytical results should be applicable to similar elderly populations in other countries.
authors.affiliation: Graduate Institute of Healthcare Administration, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
authors.forename: King-Teh
authors.initials: KT
authors.lastname: Lee
authors.forename: Yih-Huei
authors.initials: YH
authors.lastname: Uen
authors.forename: Chong-Chi
authors.initials: CC
authors.lastname: Chiu
authors.forename: Hao-Hsien
authors.initials: HH
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000191:economics*; D017081:Cholecystectomy, Laparoscopic / Q000191:economics; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006295:Health Resources; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan
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