title: Recurrence of biliary disease following non-operative management in elderly patients.
abstract: BACKGROUND
  The purpose of this study was to determine the proportion of symptomatic recurrence following initial non-operative management of gallstone disease in the elderly and to test possible predictors.
  
  
  METHODS
  This is a single institution retrospective chart review of patients 65 years and older with an initial hospital visit (V1) for symptomatic gallstone disease, over a 4-year period. Patients with initial "non-operative" management were defined as those without surgery at V1 and without elective surgery at visit 2 (V2). Baseline characteristics included age, sex, Charlson comorbidity index (CCI), diagnosis, and interventions (ERCP or cholecystostomy) at V1. Outcomes assessed over 1 year were as follows: recurrence (any ER/admission visit following V1), surgery, complications, and mortality. A survival analysis using a Cox proportional hazards model was performed to assess predictors of recurrence.
  
  
  RESULTS
  There were 195 patients initially treated non-operatively at V1. Mean age was 78.3 ± 7.8 years, 45.6% were male, and the mean CCI was 2.1 ± 1.9. At V1, 54.4% had a diagnosis of biliary colic or cholecystitis, while 45.6% had a diagnosis of cholangitis, pancreatitis, or choledocholithiasis. 39.5% underwent ERCP or cholecystostomy. Excluding 10 patients who died at V1, 31.3% of patients had a recurrence over the study period. Among these, 43.5% had emergency surgery, 34.8% had complications, and 4.3% died. Median time to first recurrence was 2 months (range 6 days-4.8 months). Intervention at V1 was associated with a lower probability of recurrence (HR 0.3, CI [0.14-0.65]).
  
  
  CONCLUSIONS
  One-third of elderly patients will develop a recurrence following non-operative management of symptomatic biliary disease. These recurrences are associated with significant rates of emergency surgery and morbidity. Percutaneous or endoscopic therapies may decrease the risk of recurrence.
authors: Department of Surgery, Jewish General Hospital, McGill University, Pavilion A-515, 3755 Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada. simon.bergman@mcgill.ca.|Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada. simon.bergman@mcgill.ca.|Solidage-McGill University/Université de Montréal Research Group on Frailty and Aging, Lady Davis Institute for Medical Research, Montreal, QC, Canada. simon.bergman@mcgill.ca.
authors: Simon
authors: S
authors: Bergman
authors: Department of Surgery, Jewish General Hospital, McGill University, Pavilion A-515, 3755 Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.
authors: Mohammed
authors: M
authors: Al-Bader
authors: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.|Solidage-McGill University/Université de Montréal Research Group on Frailty and Aging, Lady Davis Institute for Medical Research, Montreal, QC, Canada.
authors: Nadia
authors: N
authors: Sourial
authors: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.|Solidage-McGill University/Université de Montréal Research Group on Frailty and Aging, Lady Davis Institute for Medical Research, Montreal, QC, Canada.
authors: Isabelle
authors: I
authors: Vedel
authors: Department of Surgery, Jewish General Hospital, McGill University, Pavilion A-515, 3755 Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.
authors: Wael C
authors: WC
authors: Hanna
authors: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.
authors: Aaron J
authors: AJ
authors: Bilek
authors: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.
authors: Christos
authors: C
authors: Galatas
authors: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.
authors: Jonah E
authors: JE
authors: Marek
authors: Department of Surgery, Jewish General Hospital, McGill University, Pavilion A-515, 3755 Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.
authors: Shannon A
authors: SA
authors: Fraser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D002761:Cholangitis / Q000601:surgery; D002764:Cholecystitis / Q000601:surgery; D002767:Cholecystostomy / Q000706:statistics & numerical data; D042883:Choledocholithiasis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D042882:Gallstones / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005767:Gastrointestinal Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000601:surgery; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: CBD (common bile duct); Cholecystectomy; Clinical papers/trials/research; ERCP (endoscopic retrograde cholangiopancreatography); Elderly; Gallstones