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

Publicated to:Updates in Surgery. 74 (3): 979-989 - 2022-03-06 74(3), DOI: 10.1007/s13304-022-01254-0

Authors: Di Martino, Marcello; Gancedo Quintana, Alvaro; Vaello Jodra, Victor; Sanjuanbenito Dehesa, Alfonso; Morales Garcia, Dieter; Caina Ruiz, Ruben; Garcia-Moreno Nisa, Francisca; Mendoza-Moreno, Fernando; Alonso Batanero, Sara; Quinones Sampedro, Jose Edecio; Lora Cumplido, Paola; Arango Bravo, Altea; Rubio-Perez, Ines; Asensio-Gomez, Luis; Pardo Aranda, Fernando; Senti Farrarons, Sara; Ruiz Moreno, Cristina; Martinez Moreno, Clara Maria; Sarriugarte Lasarte, Aingeru; Prieto Calvo, Mikel; Aparicio-Sanchez, Daniel; Perea del Pozo, Eduardo Perea; Pellino, Gianluca; Martin-Perez, Elena

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Abstract

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.

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