title: Laparoscopic cholecystectomy is safe but underused in the elderly.
abstract: Studies confirm that laparoscopic cholecystectomy (LC) is safe and efficacious for elderly patients. The purposes of this study were to evaluate if LC is underused in the elderly and if it is a safe option in that group. Open cholecystectomy (OC) and LC were compared in nonelderly (40  to 64 years) and elderly (65 years or older) matched patient groups identified with gallbladder disease using the American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2008). Length of stay (LOS), 30-day complications, and mortality were evaluated as  outcomes. Using multivariate logistic regression, independent predictors of OC were identified. After case-matching, each group had 11,926 patients. A χ(2) test showed that elderly (20.1 vs 15.0%, P < 0.001) were more likely to undergo OC. Elderly patients had  significantly higher comorbidities and were operated on as emergent case (all P < 0.05). OC had longer LOS and mortality (all P < 0.05). Among 10 other variables in logistic regression, elderly had a higher likelihood of receiving OC (OR, 1.299; P < 0 0.001).  Significant disparity exists between elderly and nonelderly patients in use of LC surgery. LC has a lower complication rate than OC; however, elderly undergo LC less often. Awareness needs to be raised for offering earlier operative intervention and the superior results of LC in the elderly.
authors.affiliation: York Hospital, York, Pennsylvania, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Tucker
authors.forename: Franz
authors.initials: F
authors.lastname: Yanagawa
authors.forename: Rod
authors.initials: R
authors.lastname: Grim
authors.forename: Theodore
authors.initials: T
authors.lastname: Bell
authors.forename: Vanita
authors.initials: V
authors.lastname: Ahuja
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D002763:Cholecystectomy / Q000379:methods / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000601:surgery*; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D017751:Safety Management; D016896:Treatment Outcome