title: Geriatric Assessment as a qualification element for elective and emergency cholecystectomy in older patients.
abstract: BACKGROUND
  Older patients experience a higher incidence of postoperative complications after cholecystectomy compared with younger patients. However, most studies have not considered patient frailty, particularly regarding emergency cholecystectomy. The aim of this prospective study was to evaluate outcomes in frail older patients eligible for elective and emergency cholecystectomy.
  
  
  METHODS
  Preoperative Geriatric Assessment (GA) was performed in consecutive patients aged 65+ years, operated for biliary disease. The GA evaluated the functional, cognitive, comorbidity, depressive, nutritional, and polypharmacy status and patients with two or more abnormal domains were considered frail. Outcomes of interest were 30-day postoperative mortality, morbidity, and length of hospital stay (LOS).
  
  
  RESULTS
  A total of 126 patients (median age 74; range 65-93 years) were included. There was no difference between elective frail and non-frail patients regarding postoperative mortality (0 %) and morbidity (6 % vs. 5 %; p = 0.76). LOS was not significantly longer in the frail group (5.6 vs. 4 days; p = 0.22). In the emergency-admitted patients, almost all complications occurred in the frail population (mortality 5 % vs. 0 %; morbidity 36.7 % vs. 3.3 %, compared with non-frail patients, respectively; p < 0.01) and LOS was significantly longer (10.3 (frail) vs. 6 days (non-frail);p = 0.03). Frail status was a significant independent predictive factor for postoperative complications in the emergency population, only (odds ratio: 3.4 (1.2-9.7); p = 0.02).
  
  
  CONCLUSIONS
  Elective laparoscopic cholecystectomy is a safe and effective surgical technique also for older frail patients. In emergency settings, frail patients have significantly more complications and a longer LOS. However, the role of severity of frailty and the most reliable GA tools require further study.
  
  
  BACKGROUND
  ISRCTN14976998 (retrospectively registered).
authors.affiliation: 3rd Department of General Surgery, Jagiellonian University Medical College, Pradnicka str. 35-37, 31-202 Kraków, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Kenig
authors.affiliation: 3rd Department of General Surgery, Jagiellonian University Medical College, Pradnicka str. 35-37, 31-202 Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Wałęga
authors.affiliation: 3rd Department of General Surgery, Jagiellonian University Medical College, Pradnicka str. 35-37, 31-202 Kraków, Poland.
authors.forename: Urszula
authors.initials: U
authors.lastname: Olszewska
authors.affiliation: 3rd Department of General Surgery, Jagiellonian University Medical College, Pradnicka str. 35-37, 31-202 Kraków, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Konturek
authors.affiliation: 3rd Department of General Surgery, Jagiellonian University Medical College, Pradnicka str. 35-37, 31-202 Kraków, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Nowak
keywords: Cholecystectomy; Frailty; Geriatric assessment; Surgery in older patients