title: Safety of outpatient laparoscopic cholecystectomy in the elderly: analysis of 15,248 patients using the NSQIP database.
abstract: BACKGROUND
  Studies have shown that laparoscopic cholecystectomy (LC) in an ambulatory setting is a safe alternative to the traditional overnight hospital stay. However, there are limited data on the morbidity and mortality of outpatient LC in elderly patients. We evaluated the safety of ambulatory LC in the elderly and identified risk factors that predict inpatient admission.
  
  
  METHODS
  A retrospective analysis was performed using the American College of Surgeon's NSQIP database between 2007 and 2010. The database was searched for patients older than 65 years of age who underwent elective LC at all participating hospitals in the United States. Data from 15,248 patients were collected and we compared patients who underwent ambulatory procedures with those patients who were admitted for an inpatient stay.
  
  
  RESULTS
  Seven thousand four hundred and ninety-nine (48.9%) patients were ambulatory and 7,799 (51.1%) were nonambulatory. Postoperative complications included mortality (0.2% vs 1.5%; p < 0.001), stroke (0.1% vs 0.3%; p < 0.001), myocardial infarction (0.1% vs 0.6%; p < 0.001), pulmonary embolism (0.1% vs 0.3%; p = 0.005), and sepsis (0.2% vs 0.7%; p < 0.001) for ambulatory and nonambulatory cases, respectively. We identified significant independent predictors of inpatient admission and mortality, including congestive heart failure, American Society of Anesthesiologists class 4, bleeding disorder, and renal failure requiring dialysis.
  
  
  CONCLUSIONS
  We believe ambulatory LCs are safe in elderly patients as demonstrated by low complication rates. We identified multiple risk factors that might warrant inpatient hospital admission.
authors.affiliation: Department of Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Ajit
authors.initials: A
authors.lastname: Rao
authors.forename: Antonio
authors.initials: A
authors.lastname: Polanco
authors.forename: Sujing
authors.initials: S
authors.lastname: Qiu
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
authors.forename: Edward H
authors.initials: EH
authors.lastname: Chin
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
authors.forename: Scott Q
authors.initials: SQ
authors.lastname: Nguyen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors