title: Meta-analysis of laparoscopic vs open cholecystectomy in elderly patients.
abstract: OBJECTIVE
  To investigate the comparative effect of laparoscopic and open cholecystectomy in elderly patients.
  
  
  METHODS
  Laparoscopic cholecystectomy has induced a revolution in the treatment of gallbladder disease. Nevertheless, surgeons have been reluctant to implement the concepts of minimally invasive surgery in older patients. A systematic review of Medline was embarked on, up to June 2013. Studies which provided outcome data on patients aged 65 years or older, subjected to laparoscopic or open cholecystectomy were considered. Mortality, morbidity, cardiac and pulmonary complications were the outcome measures of treatment effect. The methodological quality of selected studies was appraised using valid assessment tools. Τhe random-effects model was applied to synthesize outcome data.
  
  
  RESULTS
  Out of a total of 337 records, thirteen articles (2 randomized and 11 observational studies) reporting on the outcome of 101559 patients (48195 in the laparoscopic and 53364 in the open treatment group, respectively) were identified. Odds ratios (OR) were constantly in favor of laparoscopic surgery, in terms of mortality (1.0% vs 4.4%, OR = 0.24, 95%CI: 0.17-0.35, P < 0.00001), morbidity (11.5% vs 21.3%, OR = 0.44, 95%CI: 0.33-0.59, P < 0.00001), cardiac (0.6% vs 1.2%, OR = 0.55, 95%CI: 0.38-0.80, P = 0.002) and respiratory complications (2.8% vs 5.0%, OR = 0.55, 95%CI: 0.51-0.60, P < 0.00001). Critical analysis of solid study data, demonstrated a trend towards improved outcomes for the laparoscopic concept, when adjusted for age and co-morbid diseases.
  
  
  CONCLUSIONS
  Further high-quality evidence is necessary to draw definite conclusions, although best-available evidence supports the selective use of laparoscopy in this patient population.
authors.affiliation: Stavros A Antoniou, Frank A Granderath, Center for Minimally Invasive Surgery, Hospital Neuwerk, 41066 Mönchengladbach, Germany.
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Antoniou
authors.affiliation: Stavros A Antoniou, Frank A Granderath, Center for Minimally Invasive Surgery, Hospital Neuwerk, 41066 Mönchengladbach, Germany.
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
authors.affiliation: Stavros A Antoniou, Frank A Granderath, Center for Minimally Invasive Surgery, Hospital Neuwerk, 41066 Mönchengladbach, Germany.
authors.forename: Oliver O
authors.initials: OO
authors.lastname: Koch
authors.affiliation: Stavros A Antoniou, Frank A Granderath, Center for Minimally Invasive Surgery, Hospital Neuwerk, 41066 Mönchengladbach, Germany.
authors.forename: Rudolph
authors.initials: R
authors.lastname: Pointner
authors.affiliation: Stavros A Antoniou, Frank A Granderath, Center for Minimally Invasive Surgery, Hospital Neuwerk, 41066 Mönchengladbach, Germany.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Granderath
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016017:Odds Ratio; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Complications; Elderly; Geriatric; Laparoscopic; Morbidity; Mortality; Older; Open cholecystectomy; Surgery