Abstract
Background
The prevalence of symptomatic gallbladder diseases increases with age. The present study evaluated cholecystectomy risk factors and hospital resource utilization in an elderly (aged 60 years and older) population of patients who had undergone open cholecystectomy (OC) or laparoscopic cholecystectomy (LC).
Methods
The study analyzed 20,538 OC and 29,318 LC procedures performed in Taiwan from 1996 to 2007. Odds ratio (OR) and 95% confidence interval were calculated to assess the relative change rate. Regression models were employed to predict length of stay (LOS) and total surgical cost.
Results
Patient characteristics associated with increased likelihood of undergoing LC were age 60–69 years, female gender, and lack of current co-morbidities. Length of stay associated with both OC and LC decreased during the study period. Total surgical cost for elderly OC patients increased during the study period, whereas that for elderly LC patients declined. Compared to OC patients, LC patients had significantly larger changes in LOS (−2.27 days) and total surgical cost ($ −368.64 U.S. dollars) (p < 0.001). The following factors were associated with considerable increases in both LOS and total surgical cost: advanced age, female gender, presence of one or more co-morbidities, treatment in a regional or a district hospital, and long LOS.
Conclusions
Decreases in hospital resource utilization were larger in elderly LC patients than in elderly OC patients. Health care providers and patients should observe that hospital resource utilization may depend on hospital attributes as well as patient attributes. These analytical results should be applicable to similar elderly populations in other countries.
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References
Bodmer M, Brauchli YB, Krähenbühl S et al (2009) Statin use and risk of gallstone disease followed by cholecystectomy. JAMA 302:2001–2007
Khan M, Qadri SJ, Nazir SS (2010) Use of rigid nephroscope for laparoscopic common bile duct exploration—a single-center experience. World J Surg 34:784–790
Mancero JM, D’Albuquerque LA, Gonzalez AM et al (2008) Laparoscopic cholecystectomy in cirrhotic patients with symptomatic cholelithiasis: a case–control study. World J Surg 32:267–270
Massarweh NN, Legner VJ, Symons RG et al (2010) Impact of advancing age on abdominal surgical outcomes. Arch Surg 144:1108–1114
Kaya IO, Ozkardes A, Ozdemir F et al (2008) Laparoscopic cholecystectomy in elderly people: does advanced age present any risk for conversion? J Am Geriatr Soc 56:962–963
Kwon AH, Matsui Y (2006) Laparoscopic cholecystectomy in patients aged 80 years and over. World J Surg 30:1204–1210
Lang HC, Chi C, Liu CM (2004) Impact of the case payment reimbursement method on the utilization and costs of laparoscopic cholecystectomy. Health Policy 67:195–206
Csikesz N, Ricciardi R, Tseng JF et al (2008) Current status of surgical management of acute cholecystitis in the United States. World J Surg 32:2230–2236
Kazis LE, Anderson JJ, Meenan RF (1989) Effect sizes for interpreting changes in health status. Med Care 27:178–189
Chang E, Abrahamowicz M, Ferland D et al (2002) Comparison of the responsiveness of lupus disease activity measures to changes in systemic lupus erythematosus activity relevant to patients and physicians. J Clin Epidemiol 55:488–497
Csikesz NG, Tseng JF, Shah SA (2008) Trends in surgical management for acute cholecystitis. Surgery 144:283–289
Gurusamy K, Samraj K, Gluud C et al (2010) Meta-analysis of randomised controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 97:141–150
Lee MT, Hsi SC, Hu P et al (2007) Biliopleural fistula: a rare complication of percutaneous transhepatic gallbladder drainage. World J Gastroenterol 13(23):3268–3270
Zacks SL, Sandler RS, Rutledge R et al (2002) A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol 97:334–340
Richards C, Edwards J, Culver D et al (2003) Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection? National Nosocomial Infections Surveillance (NNIS) System, Centers for Disease Control and Prevention. Ann Surg 237:358–362
Carbonell AM, Lincourt AE, Kercher KW et al (2005) Do patient or hospital demographics predict cholecystectomy outcomes? A nationwide study of 93, 578 patients. Surg Endosc 19:767–773
Polychronidis A, Botaitis S, Tsaroucha A et al (2008) Laparoscopic cholecystectomy in elderly patients. J Gastrointest Liver Dis 17:309–313
Psaila J, Agrawal S, Fountain U et al (2008) Day-surgery laparoscopic cholecystectomy: factors influencing same-day discharge. World J Surg 32:76–81
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Shi, HY., Lee, KT., Uen, YH. et al. Changing Approaches to Cholecystectomy in Elderly Patients: A 10-Year Retrospective Study in Taiwan. World J Surg 34, 2922–2931 (2010). https://doi.org/10.1007/s00268-010-0781-0
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DOI: https://doi.org/10.1007/s00268-010-0781-0