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How Safe is Performing Cholecystectomy in the Oldest Old? A 15-year Retrospective Study from a Single Institution

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Abstract

Background

Globally, the number of people aged 80 years or over, the “oldest old,” is the fastest growing population group. Because of the strong association between age and gallstone disease, both prevalence and incidence of this disease are increasing. The feasibility of the cholecystectomy in octogenarians has been evaluated in several studies that confirmed the safety of the operation. However, the safety of this procedure in nonagenarians is still controversial. The aim of this study was to evaluate the safety of cholecystectomies in nonagenarians and identify related predictors for postoperative hospital length of stay (LOS) and in-hospital mortality up to 30 days postoperatively.

Methods

More than 500 cholecystectomies, both open and laparoscopic, were performed between January 2000 and September 2015 at our institution in patients 80 years and older. These statistics include both elective and emergent admissions. A retrospective review of charts over the last 15 years was conducted to compare mortality and length of postoperative stay among two patient groups: 319 octogenarians and 36 nonagenarians. Parameters evaluated include demographics, surgical presentation, American Society of Anesthesiologists (ASA) score, main diagnosis, comorbidities, type of surgery performed, LOS and in-hospital mortality. All data were analyzed with STATA (v.13) software, using a multivariate logistic regression after determining the statistically significant variables through a stepwise regression.

Conclusions

We found out that being nonagenarian, compared to octogenarian, is not a significant risk factor in terms of LOS and in-hospital mortality within 30 days postoperatively. Despite that, the mortality rate among nonagenarians is still remarkably high as almost every patient was admitted in an emergent setting. The most remarkable predictor for mortality among the two groups was an “afternoon/night emergency” surgical presentation (OR 25.5, CI 1.53–42.35, p = 0.02). Thus, the surgical emergency management for gallbladder disease at our institution should be critically reevaluated. Performing the procedure in laparoscopy predicted a significant reduction (−5 days, CI −8.5 to −1.4, p = 0.006) of LOS, while presenting with “gallbladder and bile duct stones” (+6.3 days, CI 1.5–11.1, p = 0.01) or “acalculous cholecystitis” (+4.7 days, CI 0.4–9.2, p = 0.03) had the opposite effect. Despite the remarkable mortality rate of our series, being nonagenarian should not be considered as a reason to avoid gallbladder surgery in case of need. Our study suggests that nonagenarians are more suitable surgical candidates than may have previously expected.

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Acknowledgements

We would like to thank Dr. Fabrizio Michelassi, Dr. Luca Stocchi and Sherman Kwan for their significant contribution in drafting this manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Matteo Novello, Matteo Bianchin, Lorenzo Maestri, Francesco Vito Mandarino, Giuseppe Cavallari & Bruno Nardo

  2. Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy

    Davide Gori

  3. Department of Surgery, Carlo Alberto Pizzardi Maggiore Hospital, Largo Nigrisoli 2, Bologna, Italy

    Salomone Di Saverio

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  1. Matteo Novello
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Correspondence to Salomone Di Saverio.

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Novello, M., Gori, D., Di Saverio, S. et al. How Safe is Performing Cholecystectomy in the Oldest Old? A 15-year Retrospective Study from a Single Institution. World J Surg 42, 73–81 (2018). https://doi.org/10.1007/s00268-017-4147-8

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