title: Cholecystectomy in the very elderly--is 90 the new 70?
abstract: BACKGROUND
  Nonagenarians are the fastest growing sector of population across Western Europe. Although prevalence of gallstone disease is high, elective cholecystectomy is still controversial in this age group.
  
  
  METHODS
  A retrospective chart review was conducted of cholecystectomies done in patients over 90 years of age at our institution between 2004 and December 2009. During this period, a total of 3,009 cholecystectomies were performed on patients of all ages. Data collected included demographics, patient comorbidities, indications for surgery, type of surgery performed, intraoperative findings, histology, perioperative morbidity and mortality.
  
  
  RESULTS
  Twenty-two nonagenarians (18 females) underwent cholecystectomy during the study period. Of these patients, 19 patients (86%) had diabetes, 16 (73%) had hypertension, and 10 (45%) had coronary artery disease. Twenty patients (91%) underwent an emergency procedure. In two patients, cholecystectomy was indicated for non-resolving pain after attempted conservative therapy, only two patients were operated electively. Laparoscopic cholecystectomy was attempted in 13 patients (59%), 3 patients needed a conversion, and 9 patients (41%) considered unfit to undergo a laparoscopic approach had an open procedure. Mean operation time was 83 min. Histology showed gangrenous cholecystitis in six (27%) patients. The mean length of stay was 10 days (4-23 days). Two patients (8.3%) required intensive care following surgery. There were no common bile duct injuries, one patient had a cystic stump leak. One patient died in the postoperative period (4.6%). All patients with an emergency operation were classified as at least ASA III. Conversion rate, percentage of open procedures, percentage of advanced histology, ASA score, and hospital stay were significantly higher when compared to all patients.
  
  
  CONCLUSIONS
  Our study demonstrates that in unselected nonagenarians,cholecystectomy is safe with acceptable perioperative morbidity and mortality even as an emergency procedure. However, our data also suggests that cholecystitis appears to be a neglected condition in this age group.
authors.affiliation: Department of Surgery, Klinikum Nürnberg, Nuremberg, Germany. dubeczattila@GMAIL.COM
authors.forename: Attila
authors.initials: A
authors.lastname: Dubecz
authors.forename: Miriam
authors.initials: M
authors.lastname: Langer
authors.forename: Rudolf J
authors.initials: RJ
authors.lastname: Stadlhuber
authors.forename: Michael
authors.initials: M
authors.lastname: Schweigert
authors.forename: Norbert
authors.initials: N
authors.lastname: Solymosi
authors.forename: Marcus
authors.initials: M
authors.lastname: Feith
authors.forename: Hubert J
authors.initials: HJ
authors.lastname: Stein
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000401:mortality / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000401:mortality / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D042882:Gallstones / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome