Is day-surgery laparoscopic cholecystectomy contraindicated in the elderly? Results from a retrospective study and literature review

• DOI: 10.1016/j.ijsu.2016.06.024
• Publication Date: 2016-06-25T19:18:57Z
• Authors: Nicola Carlomagno; Vincenzo Tammaro; Alessandro Scotti; Maria Candida; Armando Calogero; Michele L. Santan...
• Keywords: Adult; Male; Health Services for the Aged; Cost-Benefit Analysis; Patient Readmission; Laparoscopic cholecystectomy; Young Adult; 03 medical and health sciences; Elderly; Laparoscopic; Postoperative Complications; 0302 clinical medicine; Cholelithiasis; Gallstone disease; Ambulatory Care; Humans; Cholecystectomy; Intraoperative Complications; Aged; Retrospective Studies; Day surgery; Elderly; Gallstone disease; Laparoscopic cholecystectomy; Morbidity; Adult; Age Factors; Aged; Ambulatory Care; Ambulatory Surgical Procedures; Cholecystectomy, Laparoscopic; Cholelithiasis; Cost-Benefit Analysis; Female; Health Services for the Aged; Humans; Intraoperative Complications; Italy; Male; Middle Aged; Patient Readmission; Postoperative Complications; Retrospective Studies; Young Adult; Surgery; Age Factors; Middle Aged; 3. Good health; Ambulatory Surgical Procedures; Cholecystectomy, Laparoscopic; Italy; Surgery; Female; Day surgery; Morbidity

Ideally, day-surgery laparoscopic cholecystectomy (DLC) combines patient satisfaction with cost-effectiveness. However, DLC has not yet been widely applied in the elderly. Thus, to challenge the current perception of DLC as a contraindication, several parameters were investigated for the feasibility of DLC within the general and elderly population. A retrospective study was conducted to analyse age, along with other relevant patient characteristics, as factors leading to successful 24-h discharge.Data were collected from 207 patients who underwent laparoscopic cholecystectomy (LC) between 2010 and 2013. Of these patients, 154 were aged <75 years and 53 > 75 years, with a median age of 59.3 years. Comparisons of the length of post-surgical hospital stay were made. Further, the parameters influencing the surgeon's decision to discharge patients within a 24-h period were investigated: demographic data; patient characteristics such as age, sex and concomitant diseases; disease presentation; surgical experience; intraoperative complications; and post-operative course. The numbers of hospital readmissions and reoperations were established as parameters of failure.Forty-five (21.7%) patients remained hospitalized up to 24 h. The majority of them had no co-morbidities, low American Society of Anesthesiologists (ASA) grades, adenomas and uncomplicated gallstone disease. Eleven patients were aged >75 years. None of the patients died, whereas one patient was readmitted following DLC.Age itself did not prove to be a contraindication for DLC. The patient's general health, disease presentation and the surgeon's attitude were the main factors favouring early discharge. Patient selection and patient-care facilities were crucial for successful outcomes. Some problems due to the logistical organization of the hospital and the surgical approach, which may impede DLC acceptance, are described herein.