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Surgery Research and Practice
Volume 2019, Article ID 9709242, 8 pages
https://doi.org/10.1155/2019/9709242
Research Article

Acute Cholecystitis in Very Elderly Patients: Disease Management, Outcomes, and Risk Factors for Complications

General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avenue Alcalde Rovira Roure 80, Lleida, Spain

Correspondence should be addressed to Alfredo Escartín; moc.cam@nitracse

Received 19 November 2018; Accepted 6 January 2019; Published 3 February 2019

Academic Editor: Cosimo Sperti

Copyright © 2019 Alfredo Escartín et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. The aim of this study was to evaluate the characteristics, management, and outcomes of acute cholecystitis in patients ≥80 years. Methods. This was a retrospective analysis of data from a prospective single-center patient registry. Results. The study population was composed of 348 patients, which were divided into two groups: those younger (Group A) and those older (Group B) than the median age (85.4 years). Although demographic and clinical characteristics of the two groups were similar, the disease management was clearly different, with older patients undergoing cholecystectomy less frequently ( 46.0% in Group A vs 22.4% in Group B; ). The outcomes in both groups of age were similar, with 30-day mortality of 3.7%, morbidity of 17.2%, and readmissions of 4.2% and two-year AC recurrence in nonoperated patients of 22.5%. No differences were seen between operated and no operated patients. Severe (Grade III) AC was the only independent factor significantly associated with mortality (OR 86.05 (95% CI: 11–679); ). Conclusions. In elderly patients with AC, the choice of therapeutic options was not limited by the age per se, but rather by the disease severity (grade III AC) and/or poor physical status (ASA III-IV). In case of grade I-II AC, laparoscopic cholecystectomy can be safely performed and yield good results even in very old patients. Patients with grade III AC present high risk of morbidity and mortality, and the treatment should be individualized. ASA IV patients should avoid cholecystectomy, being antibiotic treatment and cholecystectomy the best option.