title: Non-operative management of acute cholecystitis in the elderly.
abstract: BACKGROUND
  Although cholecystectomy is the standard therapy for acute cholecystitis (AC), operative morbidity in the elderly may be high owing to medical co-morbidities and decreased physiological reserve. Outcomes of AC in the elderly have not been fully defined with regard to operative and long-term non-operative management.
  
  
  METHODS
  Patients aged 65 years or over admitted to a tertiary care centre with a diagnosis of AC between January 2000 and December 2009 were reviewed retrospectively. Patient data, operative and postoperative details were obtained. To determine cholecystectomy rates in the non-operative group, medical records were reviewed, and patients and families were interviewed.
  
  
  RESULTS
  A total of 290 patients underwent cholecystectomy during the index admission, of whom 59 (20·3 per cent) required conversion to open operation. Fifty-eight of these patients experienced 98 complications, including acute respiratory failure (27), pneumonia (18), myocardial infarction (16) and sepsis (15). Some 185 patients had non-operative treatment, of whom 67 underwent percutaneous cholecystostomy. Forty-four patients subsequently had elective cholecystectomy, with a complication rate of 23 per cent. One hundred and twenty-six patients were discharged without a plan for cholecystectomy; the rate of recurrent AC was 4 per cent among the two-thirds of patients followed to within 15 months of death. No deaths or major complications occurred among those with recurrent AC.
  
  
  CONCLUSIONS
  Despite selection of the best elderly candidates for cholecystectomy, postoperative morbidity was significant. Medical management, with interval cholecystectomy only for recurrent AC, may be appropriate in selected patients.
authors: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
authors: E A
authors: EA
authors: McGillicuddy
authors: K M
authors: KM
authors: Schuster
authors: K
authors: K
authors: Barre
authors: L
authors: L
authors: Suarez
authors: M R
authors: MR
authors: Hall
authors: G J
authors: GJ
authors: Kaml
authors: K A
authors: KA
authors: Davis
authors: W E
authors: WE
authors: Longo
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D041881:Cholecystitis, Acute / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents