학술논문
Early laparoscopic cholecystectomy in oldest-old patients: a propensity score matched analysis of a nationwide registry.
Document Type
Academic Journal
Author
Di Martino M; HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62, 4th Floor, 28006, Madrid, Spain. marcellodima@gmail.com.; Gancedo Quintana Á; HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62, 4th Floor, 28006, Madrid, Spain.; Vaello Jodra V; Hospital Universitario Ramón Y Cajal, Madrid, Spain.; Sanjuanbenito Dehesa A; Hospital Universitario Ramón Y Cajal, Madrid, Spain.; Morales García D; Hospital, Universitario Virgen De La Victoria, Málaga, Spain.; Caiña Ruiz R; Hospital Universitario Marqués De Valdecilla, Santander, Spain.; García-Moreno Nisa F; Hospital Universitario Príncipe De Asturias, Alcalá de Henares, Spain.; Mendoza-Moreno F; Hospital Universitario Príncipe De Asturias, Alcalá de Henares, Spain.; Alonso Batanero S; Complejo Asistencial Universitario Salamanca, Salamanca, Spain.; Quiñones Sampedro JE; Complejo Asistencial Universitario Salamanca, Salamanca, Spain.; Lora Cumplido P; Hospital De Cabueñes, Gijón, Spain.; Arango Bravo A; Hospital De Cabueñes, Gijón, Spain.; Rubio-Perez I; Hospital Universitario La Paz, Madrid, Spain.; Asensio-Gomez L; Hospital Universitario La Paz, Madrid, Spain.; Pardo Aranda F; Hospital Universitario Germans Trias I Pujol, Badalona, Spain.; Sentí Farrarons S; Hospital Universitario Germans Trias I Pujol, Badalona, Spain.; Ruiz Moreno C; Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Martinez Moreno CM; Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Sarriugarte Lasarte A; General Surgery Department, Cruces University Hospital, BioCruces Research Institute, University of the Basque Country, Bilbao, Spain.; Prieto Calvo M; General Surgery Department, Cruces University Hospital, BioCruces Research Institute, University of the Basque Country, Bilbao, Spain.; Aparicio-Sánchez D; Hospital Universitario Virgen Del Rocío, Seville, Spain.; Perea Del Pozo EP; Hospital Universitario Virgen Del Rocío, Seville, Spain.; Pellino G; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.; Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.; Martin-Perez E; HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62, 4th Floor, 28006, Madrid, Spain.
Source
Publisher: Springer-Verlag Italia Country of Publication: Italy NLM ID: 101539818 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2038-3312 (Electronic) Linking ISSN: 2038131X NLM ISO Abbreviation: Updates Surg Subsets: MEDLINE
Subject
Language
English
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.
(© 2022. Italian Society of Surgery (SIC).)
(© 2022. Italian Society of Surgery (SIC).)