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Cholecystectomy Vs. Cholecystostomy for the Management of Acute Cholecystitis in Elderly Patients

  • 2018 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Data comparing outcomes following cholecystectomy and cholecystostomy tube placement (CTP) in elderly patients are lacking. We aimed to compare the post-procedural outcomes between cholecystectomy and CTP in elderly patients with acute cholecystitis.

Methods

We performed a retrospective, population-based analysis using the National Inpatient Sample for the period 2000–2014. Patients ≥ 65 years old admitted with a primary diagnosis of acute cholecystitis and who underwent either cholecystectomy or CTP during their hospitalization were included. Multivariable linear and logistic regression models were used to analyze post-procedural complications, mortality, length of stay, and total charges. The effect of procedure type on patient outcomes, stratified by acalculous and calculous cholecystitis, was also performed.

Results

A total of 200,915 patients were included, of which 7516 underwent CTP and 193,399 underwent cholecystectomy. The median age of patients undergoing CTP and cholecystectomy was 80 (IQR 73–87) and 75 (IQR 70–81), respectively. Patients undergoing CTP were more likely to have post-procedural infection (OR 2.25; 95% CI 2.07, 2.45), bleeding (OR 1.28; 95% CI 1.19, 1.37), and inpatient mortality (OR 9.27; 95% CI 7.95, 10.81). On average, CTP patients stayed 1.25 days longer (95% CI 1.14, 1.37) in hospital after the procedure. The benefits of cholecystectomy were consistent in patients with acalculous and calculous cholecystitis.

Conclusions

Elderly patients with both acalculous and calculous acute cholecystitis managed with CTP have higher incidences of post-procedural morbidity and mortality, and longer post-procedure length of hospital stay, as compared to cholecystectomy. Unless prohibitive surgical risks exist, elderly patients with acute cholecystitis should undergo cholecystectomy.

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Authors and Affiliations

  1. Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA

    Francisco Schlottmann, Charles Gaber, Paula D. Strassle, Marco G. Patti & Anthony G. Charles

  2. Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina

    Francisco Schlottmann

  3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Charles Gaber & Paula D. Strassle

  4. Department of Medicine, |University of North Carolina, Chapel Hill, NC, USA

    Marco G. Patti

Authors
  1. Francisco Schlottmann
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  2. Charles Gaber
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  3. Paula D. Strassle
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  4. Marco G. Patti
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  5. Anthony G. Charles
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Contributions

Francisco Schlottmann, Charles Gaber, Paula Strassle, Marco G. Patti, and Anthony G. Charles conceived the study and helped with literature search and writing of the manuscript.

Corresponding author

Correspondence to Francisco Schlottmann.

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The authors declare that they have no conflict of interest.

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Schlottmann, F., Gaber, C., Strassle, P.D. et al. Cholecystectomy Vs. Cholecystostomy for the Management of Acute Cholecystitis in Elderly Patients. J Gastrointest Surg 23, 503–509 (2019). https://doi.org/10.1007/s11605-018-3863-1

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  • DOI: https://doi.org/10.1007/s11605-018-3863-1

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