Early laparoscopic cholecystectomy in oldest-old patients: a propensity score matched analysis of a nationwide registry

• Published in: Updates in surgery Vol. 74; no. 3; pp. 979 - 989
• Main Authors: Di Martino, Marcello, Gancedo Quintana, Álvaro, Vaello Jodra, Víctor, Sanjuanbenito Dehesa, Alfonso, Morales García, Dieter, Caiña Ruiz, Rubén, García-Moreno Nisa, Francisca, Mendoza-Moreno, Fernando, Alonso Batanero, Sara, Quiñones Sampedro, José Edecio, Lora Cumplido, Paola, Arango Bravo, Altea, Rubio-Perez, Ines, Asensio-Gomez, Luis, Pardo Aranda, Fernando, Sentí Farrarons, Sara, Ruiz Moreno, Cristina, Martinez Moreno, Clara Maria, Sarriugarte Lasarte, Aingeru, Prieto Calvo, Mikel, Aparicio-Sánchez, Daniel, Perea del Pozo, Eduardo Perea, Pellino, Gianluca, Martin-Perez, Elena
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2022
• Subjects: Medicine; Medicine & Public Health; Original Article; Surgery; Cholecystectomy; Early laparoscopic cholecystectomy; Acute calcolous cholecystitis; Cholecystitis; Elderly
• ISSN: 2038-131X; 2038-3312
• DOI: 10.1007/s13304-022-01254-0

The role of early laparoscopic cholecystectomy (ELC) in “oldest-old” patients with acute calculous cholecystitis (ACC) is still controversial. The aim of this study is to assess the safety of ELC for ACC in ≥ 85-year-old patients. Multicentric retrospective study that analysed data of patients who underwent ELC for ACC between 2013 and 2018. Patients ≥ 85-year-old (oldest-old patients) were compared with younger patients, before and after propensity score matching (PSM). The main outcomes were mortality, post-operative complications, length of stay (LOS), and readmissions. The study included 1670 patients. The unmatched comparison revealed a selection bias towards the oldest-old group, which was associated with higher Charlson Comorbidity Index (5 vs 1, p  < 0.001), more ASA III/IV subjects (54.2% vs 19.3%, p  < 0.001), class II/III ACC (80.1% vs 69.1%, p  = 0.016) and higher Chole-Risk Score ( p  > 0.001). The oldest-old also required more conversion to open surgery (20% vs 10.3%, p  = 0.005). Postoperatively, they had a higher 90-day mortality rate (7.6% vs 1%, p  < 0.001), more total complications (40.6% vs 17.7%, p  < 0.001), complications ≥ IIIa Clavien–Dindo (14.4% vs 5.8%, p  = 0.002), longer LOS (6 vs 5 days, p  < 0.001), and more readmissions (6.6% vs 2.6%, p  < 0.001). After PSM ( n  = 206), the two groups were comparable in terms of baseline characteristics and intraoperative outcomes. No differences were observed in post-operative complications; bile leak; incisional, intrabdominal, urinary or respiratory tract infections; LOS or readmissions. In the oldest-old, ELC for ACC is still associated with significant morbidity and mortality. However, it seems to be safe in selected patients. Therefore, age itself should not be regarded as a contraindication to ELC for ACC.