title: Gallstone-related disease in the elderly: is there room for improvement?
abstract: OBJECTIVE
  Elderly patients are frequently affected by gallstone-related disease. Current guidelines support cholecystectomy after a first acute biliary complication. In the aging, these recommendations are irregularly followed.
  
  
  METHODS
  We analyzed data from patients 65 or older admitted between June 30, 2004 and June 30, 2013 with a diagnosis of acute pancreatitis, cholangitis, or cholecystitis. Diagnosis and severity assessment were defined according to current guidelines. Harms, mortality, and cholecystectomy rates were evaluated. Baseline factors independently predicting cholecystectomy were identified.
  
  
  RESULTS
  A total of 491 patients were included. The median age was 78.8 years, and 51.7 % were women. Acute cholecystitis was present in 51.7 %, acute pancreatitis in 36.5 %, and acute cholangitis in 11.8 %. Cholecystectomy was performed in 47.1 %. Age, myocardial infarct, dementia, diabetes, nonmetastatic tumor, and severe liver disease were risk factors for not undergoing surgery. Complications related to hospital stay appeared in 33 % of patients. Surgery, cholecystostomy, and ERCP presented harms in 21-25 %. Overall mortality rate was 5.4 %: 10.4 % in acute cholangitis, 6.8 % in acute cholecystitis, and 2.2 % in acute pancreatitis. Mild cases presented a 1.3 % mortality, while 28.6 % of severe cases died. After discharge, 24.7 % of patients presented a new biliary complication, 9.7 % of them severe. Relapse was more frequent in patients managed without invasive procedures, 42.3 % than in cholecystectomy patients, 9.9 % (p < 0.001) and than in ERCP patients, 19.4 % (p = 0.01).
  
  
  CONCLUSIONS
  Cholecystectomy should be recommended to elderly patients after a first acute biliary complication. If not previously performed, ERCP should be offered as an alternative when surgery is contraindicated or refused.
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Camino del Molino 2, 28942, Fuenlabrada, Madrid, Spain, fj.garcia.alonso@gmail.com.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: García-Alonso
authors.forename: María
authors.initials: M
authors.lastname: de Lucas Gallego
authors.forename: Daniel
authors.initials: D
authors.lastname: Bonillo Cambrodón
authors.forename: Alicia
authors.initials: A
authors.lastname: Algaba
authors.forename: Gema
authors.initials: G
authors.lastname: de la Poza
authors.forename: Rosa María
authors.initials: RM
authors.lastname: Martín-Mateos
authors.forename: Fernando
authors.initials: F
authors.lastname: Bermejo
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002761:Cholangitis / Q000453:epidemiology / Q000601:surgery; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome