title: Is day-surgery laparoscopic cholecystectomy contraindicated in the elderly? Results from a retrospective study and literature review.
abstract: OBJECTIVE
  Ideally, day-surgery laparoscopic cholecystectomy (DLC) combines patient satisfaction with cost-effectiveness. However, DLC has not yet been widely applied in the elderly. Thus, to challenge the current perception of DLC as a contraindication, several parameters were investigated for the feasibility of DLC within the general and elderly population. A retrospective study was conducted to analyse age, along with other relevant patient characteristics, as factors leading to successful 24-h discharge.
  
  
  METHODS
  Data were collected from 207 patients who underwent laparoscopic cholecystectomy (LC) between 2010 and 2013. Of these patients, 154 were aged <75 years and 53 > 75 years, with a median age of 59.3 years. Comparisons of the length of post-surgical hospital stay were made. Further, the parameters influencing the surgeon's decision to discharge patients within a 24-h period were investigated: demographic data; patient characteristics such as age, sex and concomitant diseases; disease presentation; surgical experience; intraoperative complications; and post-operative course. The numbers of hospital readmissions and reoperations were established as parameters of failure.
  
  
  RESULTS
  Forty-five (21.7%) patients remained hospitalized up to 24 h. The majority of them had no co-morbidities, low American Society of Anesthesiologists (ASA) grades, adenomas and uncomplicated gallstone disease. Eleven patients were aged >75 years. None of the patients died, whereas one patient was readmitted following DLC.
  
  
  CONCLUSIONS
  Age itself did not prove to be a contraindication for DLC. The patient's general health, disease presentation and the surgeon's attitude were the main factors favouring early discharge. Patient selection and patient-care facilities were crucial for successful outcomes. Some problems due to the logistical organization of the hospital and the surgical approach, which may impede DLC acceptance, are described herein.
authors.affiliation: Abdominal Surgery, General Surgery Unit - Advanced Biomedical Science Dept, University Federico II of Naples, Via S. Pansini 5, 80131 Naples, Italy. Electronic address: nicola.anita@tiscali.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Carlomagno
authors.affiliation: Abdominal Surgery, General Surgery Unit - Advanced Biomedical Science Dept, University Federico II of Naples, Via S. Pansini 5, 80131 Naples, Italy. Electronic address: vincenzo.tammaro@unina.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tammaro
authors.affiliation: Abdominal Surgery, General Surgery Unit - Advanced Biomedical Science Dept, University Federico II of Naples, Via S. Pansini 5, 80131 Naples, Italy. Electronic address: alessandroaxelscotti@inwind.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Scotti
authors.affiliation: Abdominal Surgery, General Surgery Unit - Advanced Biomedical Science Dept, University Federico II of Naples, Via S. Pansini 5, 80131 Naples, Italy. Electronic address: mariacandida84@libero.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Candida
authors.affiliation: Abdominal Surgery, General Surgery Unit - Advanced Biomedical Science Dept, University Federico II of Naples, Via S. Pansini 5, 80131 Naples, Italy. Electronic address: armcalo@libero.it.
authors.forename: Armando
authors.initials: A
authors.lastname: Calogero
authors.affiliation: Abdominal Surgery, General Surgery Unit - Advanced Biomedical Science Dept, University Federico II of Naples, Via S. Pansini 5, 80131 Naples, Italy. Electronic address: misantan@unina.it.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Santangelo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D000556:Ambulatory Surgical Procedures; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000191:economics; D002769:Cholelithiasis / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D007431:Intraoperative Complications; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Day surgery; Elderly; Gallstone disease; Laparoscopic cholecystectomy; Morbidity