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World Journal of Emergency Surgery

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Open Access 01-12-2016 | Research article

Geriatric Assessment as a qualification element for elective and emergency cholecystectomy in older patients

Authors: Jakub Kenig, Piotr Wałęga, Urszula Olszewska, Aleksander Konturek, Wojciech Nowak

Published in: World Journal of Emergency Surgery | Issue 1/2016

Abstract

Background

Older patients experience a higher incidence of postoperative complications after cholecystectomy compared with younger patients. However, most studies have not considered patient frailty, particularly regarding emergency cholecystectomy. The aim of this prospective study was to evaluate outcomes in frail older patients eligible for elective and emergency cholecystectomy.

Methods

Preoperative Geriatric Assessment (GA) was performed in consecutive patients aged 65+ years, operated for biliary disease. The GA evaluated the functional, cognitive, comorbidity, depressive, nutritional, and polypharmacy status and patients with two or more abnormal domains were considered frail. Outcomes of interest were 30-day postoperative mortality, morbidity, and length of hospital stay (LOS).

Results

A total of 126 patients (median age 74; range 65–93 years) were included. There was no difference between elective frail and non-frail patients regarding postoperative mortality (0 %) and morbidity (6 % vs. 5 %; p = 0.76). LOS was not significantly longer in the frail group (5.6 vs. 4 days; p = 0.22). In the emergency-admitted patients, almost all complications occurred in the frail population (mortality 5 % vs. 0 %; morbidity 36.7 % vs. 3.3 %, compared with non-frail patients, respectively; p < 0.01) and LOS was significantly longer (10.3 (frail) vs. 6 days (non-frail);p = 0.03). Frail status was a significant independent predictive factor for postoperative complications in the emergency population, only (odds ratio: 3.4 (1.2–9.7); p = 0.02).

Conclusions

Elective laparoscopic cholecystectomy is a safe and effective surgical technique also for older frail patients. In emergency settings, frail patients have significantly more complications and a longer LOS. However, the role of severity of frailty and the most reliable GA tools require further study.

Trial registration

ISRCTN14976998 (retrospectively registered)

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Title: Geriatric Assessment as a qualification element for elective and emergency cholecystectomy in older patients
Authors: Jakub Kenig
Piotr Wałęga
Urszula Olszewska
Aleksander Konturek
Wojciech Nowak
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: World Journal of Emergency Surgery / Issue 1/2016
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-016-0094-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Geriatric Assessment as a qualification element for elective and emergency cholecystectomy in older patients

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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