title: Primary cholecystectomy is feasible in elderly patients with acute cholecystitis.
abstract: BACKGROUND
  While early cholecystectomy is generally accepted as the standard procedure for young and fit patients with acute cholecystitis, controversy exits on the management of elderly and severely sick patients. We postulated that primary cholecystectomy is feasible in this subgroup. The aim of this study was to compare the outcomes of young and fit patients to those of elderly patients undergoing surgery for acute cholecystitis.
  
  
  METHODS
  The outcomes of elderly patients (≥70 years) undergoing surgery for acute cholecystitis in a primary care center in Germany were retrospectively compared to those of younger patients (<70 years).
  
  
  RESULTS
  152 patients, 74 aged ≥ 70 years (study group) and 78 < 70 years (control) were included for analysis. The study group was significantly older at the time of surgery (78 vs. 68 years, p = 0.02). Severe cholecystitis was seen in a significant number of cases in the study group, p = 0.01. Equally, the mean WBC (19.5 vs. 17, p = 0.02), CRP (26 vs. 22, p = 0.04) and APACHE II score (17 vs. 8, p = 0.01) were significantly higher in the study group. There was no significant difference in the duration of anesthesia (123 vs. 133 min, p = 0.70) and surgery (72 vs. 81 min, p = 0.90) amongst both groups. There was no significant difference in rate of complication amongst both groups (24 vs. 14%, p = 0.11). Two cases of mortality were recorded (1.3%) in the study group.
  
  
  CONCLUSIONS
  The age of the patient cannot be the sole factor in deciding whether or not a patient with acute cholecystitis is fit for surgery.
authors.affiliation: Department of Surgery II, Helios Klinikum Wuppertal, Witten/Herdecke University, Heusner Str. 40, 42283, Wuppertal, Germany. peter.ambe@helios-kliniken.de.|Department of General, Visceral and Thoracic Surgery, St. Remigius Hospital Opladen, An St. Remigius 26, 51379, Leverkusen, Germany. peter.ambe@helios-kliniken.de.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Ambe
authors.affiliation: Department of Internal Medicine, St. Elisabeth Hospital Hohenlind, Werthmannstr. 1, 50935, Cologne, Germany. Sebastian.Weber@hohenlind.de.
authors.forename: Sebastian A
authors.initials: SA
authors.lastname: Weber
authors.affiliation: Department of Medical Statistics and Epidemiology, University of Colonge, Kerpener Str. 62, 50937, Cologne, Germany. Hildegard.Christ@uni-koeln.de.
authors.forename: Hildegard
authors.initials: H
authors.lastname: Christ
authors.affiliation: Department of General, Visceral and Thoracic Surgery, St. Remigius Hospital Opladen, An St. Remigius 26, 51379, Leverkusen, Germany. Wassenberg@kplus.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Wassenberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D041881:Cholecystitis, Acute / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D018579:Patient Selection; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D020379:Risk Adjustment
keywords: Acute cholecystitis; Cholecystectomy; Conversion to open surgery; Elderly patients; Laparoscopic cholecystectomy; Percutaneous cholecystotomy