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Studies confirm that laparoscopic cholecystectomy (LC) is safe and efficacious for elderly patients. The purposes of this study were to evaluate if LC is underused in the elderly and if it is a safe option in that group. Open cholecystectomy (OC) and LC were compared in nonelderly (40 to 64 years) and elderly (65 years or older) matched patient groups identified with gallbladder disease using the American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2008). Length of stay (LOS), 30-day complications, and mortality were evaluated as outcomes. Using multivariate logistic regression, independent predictors of OC were identified. After case-matching, each group had 11,926 patients. A χ^sup 2^ test showed that elderly (20.1 vs 15.0%, P < 0.001) were more likely to undergo OC. Elderly patients had significantly higher comorbidities and were operated on as emergent case (all P < 0.05). OC had longer LOS and mortality (all P < 0.05). Among 10 other variables in logistic regression, elderly had a higher likelihood of receiving OC (OR, 1.299; P < 0 0.001). Significant disparity exists between elderly and nonelderly patients in use of LC surgery. LC has a lower complication rate than OC; however, elderly undergo LC less often. Awareness needs to be raised for offering earlier operative intervention and the superior results of LC in the elderly.
IN 2003, 15 PER CENT of the population in the United States was older than 65 years. Over the past 80 years, the number of people older than 80 years of age has increased by 66 per cent.1 It has been reported that the prevalence of gallbladder disease increases with human longevity. By age 70 years, 50 per cent of women and 16 per cent of men have gallbladder disease.1 Currently, laparoscopic cholecystectomy (LC) is considered the best treatment for acute cholecystitis with fewer complications and shorter hospital stay as compared with other modalities. Elderly patients have a decreased physiological reserve and increased comorbidities, so the controversy lies in whether this population can tolerate factors associated with LC.
As late as 1999, Howard and Fromm cited a mortality rate of 12 per cent for open cholecystectomy (OC) for patients older than 80 years and demonstrated no significant difference/benefit from those undergoing LC.2 However,...