Peter C Ambe1,2, Sebastian A Weber3, Hildegard Christ4, Dirk Wassenberg5. 1. Department of Surgery II, Helios Klinikum Wuppertal, Witten/Herdecke University, Heusner Str. 40, 42283, Wuppertal, Germany. peter.ambe@helios-kliniken.de. 2. Department of General, Visceral and Thoracic Surgery, St. Remigius Hospital Opladen, An St. Remigius 26, 51379, Leverkusen, Germany. peter.ambe@helios-kliniken.de. 3. Department of Internal Medicine, St. Elisabeth Hospital Hohenlind, Werthmannstr. 1, 50935, Cologne, Germany. Sebastian.Weber@hohenlind.de. 4. Department of Medical Statistics and Epidemiology, University of Colonge, Kerpener Str. 62, 50937, Cologne, Germany. Hildegard.Christ@uni-koeln.de. 5. Department of General, Visceral and Thoracic Surgery, St. Remigius Hospital Opladen, An St. Remigius 26, 51379, Leverkusen, Germany. Wassenberg@kplus.de.
Abstract
BACKGROUND: While early cholecystectomy is generally accepted as the standard procedure for young and fit patients with acute cholecystitis, controversy exits on the management of elderly and severely sick patients. We postulated that primary cholecystectomy is feasible in this subgroup. The aim of this study was to compare the outcomes of young and fit patients to those of elderly patients undergoing surgery for acute cholecystitis. METHODS: The outcomes of elderly patients (≥70 years) undergoing surgery for acute cholecystitis in a primary care center in Germany were retrospectively compared to those of younger patients (<70 years). RESULTS: 152 patients, 74 aged ≥ 70 years (study group) and 78 < 70 years (control) were included for analysis. The study group was significantly older at the time of surgery (78 vs. 68 years, p = 0.02). Severe cholecystitis was seen in a significant number of cases in the study group, p = 0.01. Equally, the mean WBC (19.5 vs. 17, p = 0.02), CRP (26 vs. 22, p = 0.04) and APACHE II score (17 vs. 8, p = 0.01) were significantly higher in the study group. There was no significant difference in the duration of anesthesia (123 vs. 133 min, p = 0.70) and surgery (72 vs. 81 min, p = 0.90) amongst both groups. There was no significant difference in rate of complication amongst both groups (24 vs. 14%, p = 0.11). Two cases of mortality were recorded (1.3%) in the study group. CONCLUSION: The age of the patient cannot be the sole factor in deciding whether or not a patient with acute cholecystitis is fit for surgery.
BACKGROUND: While early cholecystectomy is generally accepted as the standard procedure for young and fit patients with acute cholecystitis, controversy exits on the management of elderly and severely sick patients. We postulated that primary cholecystectomy is feasible in this subgroup. The aim of this study was to compare the outcomes of young and fit patients to those of elderly patients undergoing surgery for acute cholecystitis. METHODS: The outcomes of elderly patients (≥70 years) undergoing surgery for acute cholecystitis in a primary care center in Germany were retrospectively compared to those of younger patients (<70 years). RESULTS: 152 patients, 74 aged ≥ 70 years (study group) and 78 < 70 years (control) were included for analysis. The study group was significantly older at the time of surgery (78 vs. 68 years, p = 0.02). Severe cholecystitis was seen in a significant number of cases in the study group, p = 0.01. Equally, the mean WBC (19.5 vs. 17, p = 0.02), CRP (26 vs. 22, p = 0.04) and APACHE II score (17 vs. 8, p = 0.01) were significantly higher in the study group. There was no significant difference in the duration of anesthesia (123 vs. 133 min, p = 0.70) and surgery (72 vs. 81 min, p = 0.90) amongst both groups. There was no significant difference in rate of complication amongst both groups (24 vs. 14%, p = 0.11). Two cases of mortality were recorded (1.3%) in the study group. CONCLUSION: The age of the patient cannot be the sole factor in deciding whether or not a patient with acute cholecystitis is fit for surgery.
Entities:
Keywords:
Acute cholecystitis; Cholecystectomy; Conversion to open surgery; Elderly patients; Laparoscopic cholecystectomy; Percutaneous cholecystotomy
Authors: Peter C Ambe; Sarantos Kaptanis; Marios Papadakis; Sebastian A Weber; Stefan Jansen; Hubert Zirngibl Journal: Dtsch Arztebl Int Date: 2016-08-22 Impact factor: 5.594
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Authors: Charlotte S Loozen; Hjalmar C van Santvoort; Peter van Duijvendijk; Marc Gh Besselink; Dirk J Gouma; Grard Ap Nieuwenhuijzen; Johannes C Kelder; Sandra C Donkervoort; Anna Aw van Geloven; Philip M Kruyt; Daphne Roos; Kirsten Kortram; Verena Nn Kornmann; Apollo Pronk; Donald L van der Peet; Rogier Mph Crolla; Bert van Ramshorst; Thomas L Bollen; Djamila Boerma Journal: BMJ Date: 2018-10-08