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Gallstone-related disease in the elderly: is there room for improvement?
- Source :
-
Digestive diseases and sciences [Dig Dis Sci] 2015 Jun; Vol. 60 (6), pp. 1770-7. Date of Electronic Publication: 2015 Jan 11. - Publication Year :
- 2015
-
Abstract
- Background and Aim: Elderly patients are frequently affected by gallstone-related disease. Current guidelines support cholecystectomy after a first acute biliary complication. In the aging, these recommendations are irregularly followed.<br />Methods: We analyzed data from patients 65 or older admitted between June 30, 2004 and June 30, 2013 with a diagnosis of acute pancreatitis, cholangitis, or cholecystitis. Diagnosis and severity assessment were defined according to current guidelines. Harms, mortality, and cholecystectomy rates were evaluated. Baseline factors independently predicting cholecystectomy were identified.<br />Results: A total of 491 patients were included. The median age was 78.8 years, and 51.7 % were women. Acute cholecystitis was present in 51.7 %, acute pancreatitis in 36.5 %, and acute cholangitis in 11.8 %. Cholecystectomy was performed in 47.1 %. Age, myocardial infarct, dementia, diabetes, nonmetastatic tumor, and severe liver disease were risk factors for not undergoing surgery. Complications related to hospital stay appeared in 33 % of patients. Surgery, cholecystostomy, and ERCP presented harms in 21-25 %. Overall mortality rate was 5.4 %: 10.4 % in acute cholangitis, 6.8 % in acute cholecystitis, and 2.2 % in acute pancreatitis. Mild cases presented a 1.3 % mortality, while 28.6 % of severe cases died. After discharge, 24.7 % of patients presented a new biliary complication, 9.7 % of them severe. Relapse was more frequent in patients managed without invasive procedures, 42.3 % than in cholecystectomy patients, 9.9 % (p < 0.001) and than in ERCP patients, 19.4 % (p = 0.01).<br />Conclusions: Cholecystectomy should be recommended to elderly patients after a first acute biliary complication. If not previously performed, ERCP should be offered as an alternative when surgery is contraindicated or refused.
- Subjects :
- Acute Disease
Aged
Aged, 80 and over
Cholangitis epidemiology
Cholangitis surgery
Cholecystitis, Acute epidemiology
Female
Guideline Adherence
Hospital Mortality
Humans
Male
Pancreatitis epidemiology
Pancreatitis surgery
Postoperative Complications mortality
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Cholecystectomy
Cholecystitis, Acute surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1573-2568
- Volume :
- 60
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Digestive diseases and sciences
- Publication Type :
- Academic Journal
- Accession number :
- 25577265
- Full Text :
- https://doi.org/10.1007/s10620-014-3497-4