title: Age-related differences pre-, intra-, and postcholecystectomy: A retrospective cohort study of 6,868 patients.
abstract: BACKGROUND
  Cholecystectomy (CCY) is increasingly performed in older individuals. We sought to examine age-related differences in pre-, intra-, and postoperative factors at a community hospital, using a very large, single-institution cholecystectomy database.
  
  
  METHODS
  A retrospective review of 6868 patients who underwent CCY from 2001 to 2013 was performed. ROC analysis identified the optimal age cutoff when complications reached a significant inflection point (<55 and ≥55 years). Multiple clinical features and outcomes were measured and compared by age. Logistic regression was used to examine how well a set of covariates predicted postoperative complications.
  
  
  RESULTS
  Older patients had significantly higher rates of comorbidities and underwent more extensive preoperative imaging. Intraoperatively, older patients had more blood loss, longer operative times, and more open operations. Postoperatively, older patients experienced more complications and had significantly different pathological findings. While holding age and gender constant, regression analyses showed that preoperative creatinine level, blood loss and history of previous operation were the strongest predictors of complications. The risk for developing complications increased by 2% per year of life.
  
  
  CONCLUSIONS
  Older patients have distinct pre-, intra-, and postoperative characteristics. Their care is more imaging- and cost-intensive. CCY in this population is associated with higher risks, likely due to a combination of comorbidities and age-related worsened physiological status. Pathologic findings are significantly different relative to younger patients. While removing the effect of age, preoperative creatinine levels, blood loss, and history of previous operation predict postoperative complications. Quantifying these differences may help to inform management decisions for older patients.
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Hadia
authors.initials: H
authors.lastname: Maqsood
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Kalpesh
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA; Department of Epidemiology & Biostatistics, George Washington Univ., Washington, DC, USA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Ferdosi
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Sill
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Buddensick
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Sautter
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Haroon
authors.initials: H
authors.lastname: Shaukat
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Gisela
authors.initials: G
authors.lastname: Sulkowski
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Dusty Marie
authors.initials: DM
authors.lastname: Narducci
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Siddique
authors.affiliation: Department of Public Health Analysis, Morgan State Univ., Baltimore, MD, USA.
authors.forename: Farin
authors.initials: F
authors.lastname: Kamangar
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Gopal C
authors.initials: GC
authors.lastname: Kowdley
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA. Electronic address: Steven.Cunningham@stagnes.org.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002763:Cholecystectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011184:Postoperative Period; D012372:ROC Curve; D012189:Retrospective Studies
keywords: Adenomyosis; Age; Cholecystectomy; Cholesterolosis; Complications; Elderly; Young