Age-related differences pre-, intra-, and postcholecystectomy: A retrospective cohort study of 6,868 patients

作者：Maqsood Hadia; Patel Kalpesh; Ferdosi Hamid; Sill Anne M; Wu Bin; Buddensick Thomas; Sautter Amanda; Shaukat Haroon; Sulkowski Gisela; Narducci Dusty Marie; Siddique Mustafa; Kamangar Farin; Kowdley Gopal C; Cunningham Steven C^*

来源：International Journal of Surgery, 2017, 39: 119-126.

DOI：10.1016/j.ijsu.2017.01.046

• Cholecystectomy
• Elderly
• Young
• Complications
• Age
• Adenomyosis
• Cholesterolosis

Background: Cholecystectomy (CCY) is increasingly performed in older individuals. We sought to examine age-related differences in pre-, intra-, and postoperative factors at a community hospital, using a very large, single-institution cholecystectomy database.
Materials and methods: A retrospective review of 6868 patients who underwent CCY from 2001 to 2013 was performed. ROC analysis identified the optimal age cutoff when complications reached a significant inflection point (< 55 and >= 55 years). Multiple clinical features and outcomes were measured and compared by age. Logistic regression was used to examine how well a set of covariates predicted postoperative complications.
Results: Older patients had significantly higher rates of comorbidities and underwent more extensive preoperative imaging. Intraoperatively, older patients had more blood loss, longer operative times, and more open operations. Postoperatively, older patients experienced more complications and had significantly different pathological findings. While holding age and gender constant, regression analyses showed that preoperative creatinine level, blood loss and history of previous operation were the strongest predictors of complications. The risk for developing complications increased by 2% per year of life.
Conclusion: Older patients have distinct pre-, intra-, and postoperative characteristics. Their care is more imaging-and cost-intensive. CCY in this population is associated with higher risks, likely due to a combination of comorbidities and age-related worsened physiological status. Pathologic findings are significantly different relative to younger patients. While removing the effect of age, preoperative creatinine levels, blood loss, and history of previous operation predict postoperative complications. Quantifying these differences may help to inform management decisions for older patients.

• 出版日期2017-3