Back to Annual Meeting Program

INTRODUCTION: We evaluated the perioperative outcomes of patients undergoing elective and emergency laparoscopic cholecystectomy (LC) who were <80 and >80 years of age.

PATIENTS AND METHODS: Patients undergoing LC for benign disease between 2005 and 2010 were identified from the ACS-NSQIP participant use file (PUF) utilizing the current procedural terminology (CPT) codes for LC with and without intraoperative cholangiogram. Patients undergoing any other procedure except a LC as identified by the CPT codes were excluded. A procedure was considered an emergency if so designated by the surgeon or anesthesiologist or if surgery was performed no later than 12 hours after the patient was admitted to the hospital or after the onset of related preoperative symptoms. Outcome measures analyzed included 30-day mortality, return to operating room, serious morbidity and overall morbidity. Serious morbidity was defined as having documentation of one of the following complications: organ space surgical site infection (SSI), wound dehiscence, neurologic event (cerebrovascular accident or coma lasting more than 24 hours) cardiac arrest, myocardial infarction, bleeding requiring transfusion of more than 4 units of packed red cells or whole blood, pulmonary embolism, ventilator dependence more than 48 hours, progressive or acute renal insufficiency, and sepsis or septic shock. Overall morbidity was defined as having documentation of a serious morbidity or at least one of the following complications: superficial SSI, deep SSI, pneumonia, unplanned intubation (without preoperative ventilator dependence), urinary tract infection, peripheral neurological deficit and deep vein thrombosis. Preoperative variables including patient characteristics and co-morbidities and postoperative outcomes were compared by age groups (<80 vs. >80 years) and operation status (elective vs. emergency). Multiple logistic regression was used to assess the influence of age and operation status on outcomes after accounting for available covariates.

RESULTS: During the study period 91,034 patients underwent LC, which represented 90% of patients undergoing a LC in the database. Patients older than 80 years were likely to have more preoperative comorbidities and worse perioperative outcomes, however the outcomes were much worse when they underwent emergency surgery. These unadjusted comparisons persisted in the multivariable analysis. Male gender and presence of medical comorbidities were also independently associated with worse perioperative outcomes. (Table)

CONCLUSIONS: Patients older than 80 years of age have more medical comorbidities and worse perioperative outcomes, particularly if they undergo emergency LC. These patients represent a high risk group and therefore in emergency situations, a non operative approach should be initially considered if feasible.

	Elective LC		Emergency LC
	≤80 years (n=79,641)	>80 years (n=3,277)	≤80 years (n=7,679)	>80 years (n=437)
Bivariate Comparisions*
30-day mortality	0.1	1.7	0.4	5.3
Serious morbidity	0.9	4	2	10
Overall morbidity	2.5	7	4	14
Return to OR	1	1.6	1.2	2.8
Male Gender	25	40	31	45
Diabetic	10	18	10	19
Pulmonary disease	7	20	5	19
Independent functional status	98	85	96	75
	30-day mortality	Serious morbidity	Overall morbidity	Return to OR
Logistic regression**
Emergency vs. elective	2.3(1.6-3.2)	2(1.6-2.2)	1.6(1.4-1.7)	1.3(1.0-1.6)
>80 vs.≤80	2.7(2.0-3.7)	1.3(1.1-1.6)	1.3(1.2-1.5)	NS
Male vs. female	NS	1.5(1.4-1.7)	1.1(1.0-1.2)	1.3(1.1-1.5)
Diabetes vs. No diabetes	NS	1.3(1.2-1.5)	1.3(1.2-1.5)	1.2(1-1.5)
Pulmonary disease vs. No pulmonary disease	2.3(1.7-1.9)	1.6(1.4-1.9)	1.5(1.3-1.6)	NS
Cardiac disease vs. No cardiac disease	1.4(1.0-1.9)	NS	NS	1.3(1.1-1.6)

* All values are expressed in percentage. ** Odds ratio (95% confidence interval) NS = Not Significant