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Stefanova I, Kyle E, Wilson I, Tobbal M, Veeramootoo D, De'Ath HD. Laparoscopic Cholecystectomy vs Endoscopic Retrograde Cholangiopancreatography With Sphincterotomy in Elderly Patients With Acute Gallstone Pancreatitis. Am Surg 2024:31348241248564. [PMID: 38636538 DOI: 10.1177/00031348241248564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND Gallstone pancreatitis (GSP) is common in elderly patients and carries worse outcomes. Laparoscopic cholecystectomy (LC) is recommended for prevention of recurrent GSP. In frail populations, an endoscopic retrograde cholangiopancreatography with sphincterotomy (ERCP-s) is an alternative. Management guidelines of GSP in the elderly are lacking. This study aimed to investigate and compare management strategies for GSP in the elderly. MATERIALS AND METHODS A retrospective comparison of outcome of patients aged ≥65 years with first presentation of GSP treated either with (1) LC only, (2) ERCP-s, (3) ERCP-S followed by LC, or (4) no intervention. RESULTS 216 patients were included. Median age was 76 years (interquartile range 70-83). Most (80%, n = 172) had mild pancreatitis, whilst 12% (n = 26) had severe disease. 24% (n = 55) were treated with ERCP-s; 40% (n = 87) underwent LC alone; 11% (n = 23) had ERCP-s followed by LC; and 25% (n = 55) received no intervention. Patients without intervention were older (P < .001) and frailer (P < .001). The LC-only group had lower post-procedure re-admission rates of 6% (n = 5) compared to 27% (n = 14) for ERCP-s, 33% (n = 7) for ERCP-S + LC, and 31% (n = 17) for the no intervention group (P = .0001). Biliary cause mortality was highest in the no intervention group (n = 11, 20%). CONCLUSION Laparoscopic cholecystectomy represents the gold standard for elderly patients with GSP.
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Affiliation(s)
- Irena Stefanova
- Department of Upper Gastrointestinal Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Ewan Kyle
- Department of Upper Gastrointestinal Surgery, Frimley Park Hospital, Portsmouth Road, Camberley, UK
| | - Iain Wilson
- Department of Upper Gastrointestinal Surgery, Wexham Park Hospital, Wexham St, Slough, UK
| | - Muhammad Tobbal
- Department of Upper Gastrointestinal Surgery, Frimley Park Hospital, Portsmouth Road, Camberley, UK
| | - Darmarajah Veeramootoo
- Department of Upper Gastrointestinal Surgery, Frimley Park Hospital, Portsmouth Road, Camberley, UK
| | - Henry D De'Ath
- Department of Upper Gastrointestinal Surgery, Frimley Park Hospital, Portsmouth Road, Camberley, UK
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Ramírez-Giraldo C, Venegas-Sanabria LC, Rojas-López S, Avendaño-Morales V. Outcomes after laparoscopic cholecystectomy in patients older than 80 years: two-years follow-up. BMC Surg 2024; 24:87. [PMID: 38475792 DOI: 10.1186/s12893-024-02383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The laparoscopic cholecystectomy is the treatment of choice for patients with benign biliary disease. It is necessary to evaluate survival after laparoscopic cholecystectomy in patients over 80 years old to determine whether the long-term mortality rate is higher than the reported recurrence rate. If so, this age group could benefit from a more conservative approach, such as antibiotic treatment or cholecystostomy. Therefore, the aim of this study was to evaluate the factors associated with 2 years survival after laparoscopic cholecystectomy in patients over 80 years old. METHODS We conducted a retrospective observational cohort study. We included all patients over 80 years old who underwent laparoscopic cholecystectomy. Survival analysis was conducted using the Kaplan‒Meier method. Cox regression analysis was implemented to determine potential factors associated with mortality at 24 months. RESULTS A total of 144 patients were included in the study, of whom 37 (25.69%) died at the two-year follow-up. Survival curves were compared for different ASA groups, showing a higher proportion of survivors at two years among patients classified as ASA 1-2 at 87.50% compared to ASA 3-4 at 63.75% (p = 0.001). An ASA score of 3-4 was identified as a statistically significant factor associated with mortality, indicating a higher risk (HR: 2.71, CI95%:1.20-6.14). CONCLUSIONS ASA 3-4 patients may benefit from conservative management due to their higher risk of mortality at 2 years and a lower probability of disease recurrence.
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Affiliation(s)
- Camilo Ramírez-Giraldo
- Surgery Department, Hospital Universitario Mayor - Méderi, Bogotá, Colombia.
- Universidad del Rosario, Bogotá, Colombia.
- Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
| | - Luis Carlos Venegas-Sanabria
- Research Department, Hospital Universitario Mayor - Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | - Susana Rojas-López
- Surgery Department, Hospital Universitario Mayor - Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
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Ramírez-Giraldo C, Rosas-Morales C, Vásquez F, Isaza-Restrepo A, Ibáñez-Pinilla M, Vargas-Rubiano S, Vargas-Barato F. Laparoscopic cholecystectomy in super elderly (> 90 years of age): safety and outcomes. Surg Endosc 2023:10.1007/s00464-023-10048-3. [PMID: 37093280 PMCID: PMC10338395 DOI: 10.1007/s00464-023-10048-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 03/26/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Nonagenarian patients are an age group in progressive growth. In this age group, indications for surgical procedures, including cholecystectomy, will be increasingly frequent, as biliary pathology and its complications are frequent in this population group. The main objective of this study was to analyze the safety and outcomes of laparoscopic cholecystectomy in patients older than 90 years. METHODS A retrospective observational cohort study was designed. This study involved 600 patients that were classified in 4 age groups for analysis (under 50 years, 50-69 years, 70-89 years, and over 90 years). Demographic, clinical, paraclinics, surgical, and outcome variables were compared according to age group. A multivariate analysis, which included variables considered clinically relevant, was performed to identify factors associated with mortality and complications classified with the Clavien-Dindo scale. RESULTS The patients evaluated had a median age of 65.0 (IQR 34.0) years and there was a female predominance (61.8%). A higher complication rate, conversion rate, subtotal cholecystectomy rate, and prolonged hospital stay were found in nonagenarians. The overall mortality rate was 1.6%. Mortality in the age group over 90 years was 6.8%. Regression models showed that age over 90 years (RR 4.6 CI95% 1.07-20.13), presence of cholecystitis (RR 8.2 CI95% 1.29-51.81), and time from admission to cholecystectomy (RR 1.2 CI95% 1.10-1.40) were the variables that presented statistically significant differences as risk factors for mortality. CONCLUSION Cholecystectomy in nonagenarian patients has a higher rate of complications, conversion rate, subtotal cholecystectomy rate, and mortality. Therefore, an adequate perioperative assessment is necessary to optimize comorbidities and improve outcomes. Also, it is important to know the greatest risk for informed consent and choose the surgical equipment and schedule of the procedure.
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Affiliation(s)
- Camilo Ramírez-Giraldo
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia.
- Universidad del Rosario, Bogotá, Colombia.
| | | | | | - Andrés Isaza-Restrepo
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | | | - Saul Vargas-Rubiano
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | - Felipe Vargas-Barato
- Hospital Universitario Mayor - Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
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Bartos A, Mărgărit S, Bocse H, Krisboi I, Iancu I, Breazu C, Plesa-Furda P, Brînzilă S, Leucuta D, Iancu C, Puia C, Al Hajjar N, Ciobanu L. Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis. Life (Basel) 2022; 12:life12111810. [PMID: 36362961 PMCID: PMC9695297 DOI: 10.3390/life12111810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background and Aims: Recent single-center retrospective studies have focused on laparoscopic pancreatoduodenectomy (LPD) in elderly patients, and compared the outcomes between the laparoscopic and open approaches. Our study aimed to determine the outcomes of LPD in the elderly patients, by performing a systematic review and a meta-analysis of relevant studies. Methods: A comprehensive literature review was conducted utilizing the Embase, Medline, PubMed, Scopus and Cochrane databases to identify all studies that compared laparoscopic vs. open approach for pancreatoduodenectomy (PD). Results: Five retrospective studies were included in the final analysis. Overall, 90-day mortality rates were significantly decreased after LPD in elderly patients compared with open approaches (RR = 0.56; 95%CI: 0.32−0.96; p = 0.037, I2 = 0%). The laparoscopic approach had similar mortality rate at 30-day, readmission rate in hospital, Clavien−Dindo complications, pancreatic fistula grade B/C, complete resection rate, reoperation for complications and blood loss as the open approach. Additionally, comparing with younger patients (<70 years old), no significant differences were seen in elderly cohort patients regarding mortality rate at 90 days, readmission rate to hospital, and complication rate. Conclusions: Based on our meta-analysis, we identify that LPD in elderly is a safe procedure, with significantly lower 90-day mortality rates when compared with the open approach. Our results should be considered with caution, considering the retrospective analyses of the included studies; larger prospective studies are required.
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Affiliation(s)
- Adrian Bartos
- Medicine Faculty, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
- Correspondence: (A.B.); (S.M.)
| | - Simona Mărgărit
- Medicine Faculty, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
- Correspondence: (A.B.); (S.M.)
| | - Horea Bocse
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
| | - Iulia Krisboi
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
| | - Ioana Iancu
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
| | - Caius Breazu
- Medicine Faculty, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
| | - Patricia Plesa-Furda
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
| | - Sandu Brînzilă
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
| | - Daniel Leucuta
- Medicine Faculty, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
| | - Cornel Iancu
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
| | - Cosmin Puia
- Medicine Faculty, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Medicine Faculty, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
| | - Lidia Ciobanu
- Medicine Faculty, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400012 Cluj-Napoca, Romania
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D'Acapito F, Solaini L, Di Pietrantonio D, Tauceri F, Mirarchi MT, Antelmi E, Flamini F, Amato A, Framarini M, Ercolani G. Which octogenarian patients are at higher risk after cholecystectomy for symptomatic gallstone disease? A single center cohort study. World J Clin Cases 2022; 10:8556-8567. [PMID: 36157828 PMCID: PMC9453367 DOI: 10.12998/wjcc.v10.i24.8556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Incidence of gallstones in those aged ≥ 80 years is as high as 38%-53%. The decision-making process to select those oldest old patients who could benefit from cholecystectomy is challenging.
AIM To assess the risk of morbidity of the “oldest-old” patients treated with cholecystectomy in order to provide useful data that could help surgeons in the decision-making process leading to surgery in this population.
METHODS A retrospective study was conducted between 2010 and 2019. Perioperative variables were collected and compared between patients who had postoperative complications. A model was created and tested to predict severe postoperative morbidity.
RESULTS The 269 patients were included in the study (193 complicated). The 9.7% of complications were grade 3 or 4 according to the Clavien-Dindo classification. Bilirubin levels were lower in patients who did not have any postoperative complications. American Society of Anesthesiologists scale 4 patients, performing a choledocholithotomy and bilirubin levels were associated with Clavien-Dindo > 2 complications (P < 0.001). The decision curve analysis showed that the proposed model had a higher net benefit than the treating all/none options between threshold probabilities of 11% and 32% of developing a severe complication.
CONCLUSION Patients with American Society of Anesthesiologists scale 4, higher level of bilirubin and need of choledocholithotomy are at the highest risk of a severely complicated postoperative course. Alternative endoscopic or percutaneous treatments should be considered in this subgroup of octogenarians.
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Affiliation(s)
- Fabrizio D'Acapito
- Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì 47121, Italy
| | - Leonardo Solaini
- Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì 47121, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40126, Italy
| | - Daniela Di Pietrantonio
- Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì 47121, Italy
| | - Francesca Tauceri
- Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì 47121, Italy
| | - Maria Teresa Mirarchi
- Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì 47121, Italy
| | - Elena Antelmi
- Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì 47121, Italy
| | - Francesca Flamini
- Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì 47121, Italy
| | - Alessio Amato
- Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì 47121, Italy
| | - Massimo Framarini
- Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì 47121, Italy
| | - Giorgio Ercolani
- Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì 47121, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40126, Italy
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Invited commentary on "Management of choledocholithiasis in the elderly: Same-admission cholecystectomy remains the standard of care". Surgery 2022; 172:1065-1066. [PMID: 35965148 DOI: 10.1016/j.surg.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022]
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Cholecystectomy after endoscopic sphincterotomy in elderly: A dilemma. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1115509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: Although cholecystectomy is recommended by many guidelines after endoscopic retrograde cholangiopancreatography (ERCP) for gallstones, the necessity of cholecystectomy in geriatric patients is a matter of debate. Here we compare the outcomes of new biliary events in cholecystectomized and non-cholecystectomized patients of geriatric age after ERCP for suspected choledocholithiasis.
Methods: Non-cholecystectomized patients who underwent ERCP for choledocholithiasis from 2015 to 2017 were included in this retrospective cohort study. Patients with other biliary pathologies, incomplete clearance of common bile duct stones, and those who could not be reached at follow-up were excluded from the study. Biliary events (cholecystitis, cholangitis, pancreatitis, re-ERCP) were evaluated by considering age groups in patients with and without cholecystectomy in their follow-up after sphincterotomy.
Results: A total of 284 patients were followed for an average of 69.77 (0.2) months. The cumulative incidence of biliary events in cholecystectomized patients was lower (16% vs. 21.5%; P < 0.001), and cholecystectomized patients had a longer time to the occurrence of events (mean 74.49 [0.27] months vs. 73.50 [0.33] months; P = 0.03). There was no significant difference in the frequency of biliary events between elderly patients with and without cholecystectomy (P = 0.81), and the cumulative incidence of biliary events in the in situ group was significantly lower than that in the geriatric group (17.5% vs 32.6%; P = 0.03)
Conclusion: Although cholecystectomy significantly reduces subsequent biliary complications in young patients, it does not provide a statistically significant benefit in geriatric patients. We believe that there may be no need for routine prophylactic cholecystectomy after endoscopic sphincterotomy in geriatric patients.
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Calini G, Brollo PP, Quattrin R, Bresadola V. Predictive Factors for Drain Placement After Laparoscopic Cholecystectomy. Front Surg 2022; 8:786158. [PMID: 35187046 PMCID: PMC8847274 DOI: 10.3389/fsurg.2021.786158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/29/2021] [Indexed: 12/07/2022] Open
Abstract
PurposeCurrently, surgical drainage during a laparoscopic cholecystectomy (LC) is still placed in selected patients. Evidence of the non-beneficial effect of the surgical drain comes from studies with a heterogeneous population. This preliminary study aims to identify any clinical, demographic, or intraoperative predictive factors for a surgical drain placement during LC as the first step to identify population for a prospective randomized study.MethodThe study was conducted in a single referral center and academic hospital between 2014 and 2018. Patients who underwent unconverted LC were divided into two groups: Group A (drain) and Group B (no drain). We explored baseline, preoperative, intraoperative characteristics, and postoperative outcomes.ResultsBetween 409 patients who underwent LC: 90 (22%) patients were in Group A (drain). Age >64 years, male sex, cholecystitis, Charlson comorbidity index (CCI) ≥ 1, experienced surgeon, intraoperative technical difficulties, need for an additional trocar, operative time >60 min, and estimated blood loss >10 ml were predictive factors at univariate analysis. While at multivariate analysis, cholecystitis (odds ratio [OR]: 2.8, 95% CI:1.5–5.1; p < 0.001), CCI ≥ 1 (OR:1.9, 95% CI:1.0–3.5; p = 0.05), intraoperative technical difficulties (OR: 3.6, 95% CI:1.8–6.2; p < 0.001), need of an additional trocar (OR: 2.5, 95% CI: 1.4–4.4; p < 0.005), and estimated blood loss >10 ml (OR: 3.0, 95% CI:1.7–5.3; p < 0.0001) were predictive factors for a surgical drain placement during LC.ConclusionsThis study identified predictive factors that currently drive the surgeons to a surgical drain placement after LC. Randomized prospective studies are needed to define the use of drain placement in these selected patients.
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Affiliation(s)
- Giacomo Calini
- Department of Medicine, General Surgery Department and Simulation Center, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Pier Paolo Brollo
- Department of Medicine, General Surgery Department and Simulation Center, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Rosanna Quattrin
- Department of Organization of Hospital Services, Academic Hospital of Udine, Udine, Italy
| | - Vittorio Bresadola
- Department of Medicine, General Surgery Department and Simulation Center, Academic Hospital of Udine, University of Udine, Udine, Italy
- *Correspondence: Vittorio Bresadola ; orcid.org/0000-0002-0098-3540
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Zhang Z, Zhao Y, Lin F, Liu L, Zhang C, Liu Z, Zhu M, Wan B, Deng H, Yang H, Jiao L, Xie X. Protective and therapeutic experience of perioperative safety in extremely elderly patients with biliary diseases. Medicine (Baltimore) 2021; 100:e26159. [PMID: 34032775 PMCID: PMC8154467 DOI: 10.1097/md.0000000000026159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/06/2021] [Indexed: 02/07/2023] Open
Abstract
To explore the protective and therapeutic measures of improving perioperative safety in extremely elderly patients with biliary diseases, so as to improve the therapeutic efficacy of surgery. A retrospective case–control study of 412 elderly patients with biliary diseases was carried out from July 2013 to July 2019. Seventy eight cases were divided into the high age (HA) group (≥80 years) and 334 into the middle–low age (MLA) group (60–79 years). In the HA compared with MLA group, 1. Preoperative coexisting diseases: the occurrence of coexisting coronary heart disease (CHD), hypertension, chronic bronchitis with emphysema, hypoproteinemia, and anemia were significantly increased; 2. Laboratory examinations: function of liver, kidneys, heart, lungs, and blood coagulation significantly declined; 3. Surgical procedures: open cholecystectomy with transcystic common bile duct (CBD) exploration significantly higher, while laparoscopic cholecystectomy significantly lower; 4. Operative effects: intraoperative blood loss, operation time, postoperative hospital stay, and length of hospitalization significantly increased or prolonged; 5. Postoperative complications: postoperative respiratory failure, pulmonary infection, anemia and electrolyte disorder significantly increased; 6. Therapeutic outcomes: no significant difference in the therapeutic effects. Although the surgical risk was significantly increased, there was no significant difference in the therapeutic efficacy in the HA compared with MLA group, suggesting that surgical treatment in extremely elderly patients with biliary diseases is safe and feasible. The key is to actively treat preoperative coexisting diseases, strictly adhere to surgical indications, reasonably select surgical procedures, precisely perform the operation, closely monitor and control intraoperative emergencies, timely prevent and treat postoperative complications, so as to improve the perioperative safety of extremely elderly patients with biliary diseases.
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Serban D, Socea B, Balasescu SA, Badiu CD, Tudor C, Dascalu AM, Vancea G, Spataru RI, Sabau AD, Sabau D, Tanasescu C. Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:230. [PMID: 33801408 PMCID: PMC8002041 DOI: 10.3390/medicina57030230] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
Background and Objectives: This study investigates the impact of age upon the safety and outcomes of laparoscopic cholecystectomy performed for acute cholecystitis, by a multivariate approach. Materials and Methods: A 2-year retrospective study was performed on 333 patients admitted for acute cholecystitis who underwent emergency cholecystectomy. The patients included in the study group were divided into four age subgroups: A ≤49 years; B: 50-64 years; C: 65-79 years; D ≥80 years. Results: Surgery after 72 h from onset (p = 0.007), severe forms, and higher American Society of Anesthesiologists Physical Status Classification and Charlson comorbidity index scores (p < 0.001) are well correlated with older age. Both cardiovascular and surgical related complications were significantly higher in patients over 50 years (p = 0.045), which also proved to be a turning point for increasing the rate of conversion and open surgery. However, the comparative incidence did not differ significantly between patients aged from 50-64 years, 65-79 years and over 80 years (6.03%, 9.09% and 5.8%, respectively). Laparoscopic cholecystectomy (LC) was the most frequently used surgical approach in the treatment of acute cholecystitis in all age groups, with better outcomes than open cholecystectomy in terms of decreased overall and postoperative hospital stay, reduced surgery related complications, and the incidence of acute cardiovascular events in the early postoperative period (p < 0.001). Conclusions: The degree of systemic inflammation was the main factor that influenced the adverse outcome of LC in the elderly. Among comorbidities, diabetes was associated with increased surgical and systemic postoperative morbidity, while stroke and chronic renal insufficiency were correlated with a high risk of cardiovascular complications. With adequate perioperative care, the elderly has much to gain from the benefits of a minimally invasive approach, which allows a decreased rate of postoperative complications and a reduced hospital stay.
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Affiliation(s)
- Dragos Serban
- 4th Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.S.); (C.D.B.); (A.M.D.); (G.V.); (R.I.S.)
| | - Bogdan Socea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.S.); (C.D.B.); (A.M.D.); (G.V.); (R.I.S.)
- Department of Surgery, “Sf. Pantelimon” Emergency Hospital, 021659 Bucharest, Romania
| | | | - Cristinel Dumitru Badiu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.S.); (C.D.B.); (A.M.D.); (G.V.); (R.I.S.)
- Department of Surgery, “Bagdasar Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania
| | - Corneliu Tudor
- 4th Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
| | - Ana Maria Dascalu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.S.); (C.D.B.); (A.M.D.); (G.V.); (R.I.S.)
| | - Geta Vancea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.S.); (C.D.B.); (A.M.D.); (G.V.); (R.I.S.)
| | - Radu Iulian Spataru
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.S.); (C.D.B.); (A.M.D.); (G.V.); (R.I.S.)
- Department of Pediatric Surgery, Emergency Clinic Hospital for Children “Maria S. Curie”, 41451 Bucharest, Romania
| | - Alexandru Dan Sabau
- 3rd Department Surgery, Faculty of Medicine, “Lucian Blaga” University Sibiu, 550169 Sibiu, Romania; (A.D.S.); (D.S.); (C.T.)
| | - Dan Sabau
- 3rd Department Surgery, Faculty of Medicine, “Lucian Blaga” University Sibiu, 550169 Sibiu, Romania; (A.D.S.); (D.S.); (C.T.)
| | - Ciprian Tanasescu
- 3rd Department Surgery, Faculty of Medicine, “Lucian Blaga” University Sibiu, 550169 Sibiu, Romania; (A.D.S.); (D.S.); (C.T.)
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Abstract
Geriatric patients tend to have subtle presentations of biliary disorders and, if untreated, can decompensate acutely. Each biliary disorder warrants formulation of an individualized treatment plan with a multidisciplinary approach. Acute cholecystitis, a common complication of gallstones, is initially managed by conservative measures and subsequently, among patients with optimal surgical risk, through laparoscopic or open cholecystectomy. High-risk patients undergo temporization, percutaneous or endoscopic, followed by definitive intervention. Acute cholecystitis with complications (ie, perforation, gangrene, or small bowel obstruction) warrants emergent cholecystectomy. Gallstone migration into the biliary system can cause choledocholithiasis, often complicated by biliary pancreatitis or cholangitis if not intervened. Therapy for choledocholithiasis is based on biliary clearance through endoscopic and, infrequently, surgical approaches.
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Li N, Xiong L, Wu YH, Chen XJ, Meng YZ, Li SF, Xiong YQ. Effects of dexmedetomidine on cognitive function in elderly patients after laparoscopic cholecystectomy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20177. [PMID: 32443335 PMCID: PMC7254565 DOI: 10.1097/md.0000000000020177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although many studies have reported the effects of dexmedetomidine on cognitive function (CF) in elderly patients after laparoscopic cholecystectomy (LCT), to this date, its effects are still not well understood. The aim of this study is to produce a qualitative synthesis of assessing the effects of dexmedetomidine on CF in elderly patients after LCT. METHODS We will conduct a comprehensive search in Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, VIP Database, WANGFANG Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from the commencement to March 31, 2020 without restrictions of language and publication status. In addition, we will also search grey literature, including conference abstracts, dissertations, reference lists of included studies and relevant reviews. All potential studies will be identified independently by 2 authors to determine their inclusion against previously defined eligibility criteria. The quality of selected papers will be assessed using Cochrane risk of bias tool. All statistical analysis will be performed using RevMan 5.3 software. RESULTS This study will provide a synthesis of the current available data on assessing the effects of dexmedetomidine on CF in elderly patients after LCT. CONCLUSIONS Its findings will provide qualitative evidence to better understand the effects of dexmedetomidine on CF in elderly patients after LCT.INPLASY Registration Number: INPLASY202040030.
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Affiliation(s)
- Na Li
- Department of Anesthesiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan
| | - Lu Xiong
- Department of Anesthesiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan
| | - Ye-Hua Wu
- Department of Anesthesiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan
| | - Xiao-Jian Chen
- Department of Anesthesiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan
| | - Ya-Zhen Meng
- Department of Anesthesiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan
| | - Shuang-Feng Li
- Department of Anesthesiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan
| | - Ya-Qin Xiong
- Department of Anesthesiology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
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