Which octogenarian patients are at higher risk after cholecystectomy for symptomatic gallstone disease? A single center cohort study  

作　　者：Fabrizio D'Acapito Leonardo Solaini Daniela Di Pietrantonio Francesca Tauceri Maria Teresa Mirarchi ElenaAntelmi Francesca Flamini Alessio Amato Massimo Framarini Giorgio Ercolani 

机构地区：[1]Department of General and Oncologic Surgery,Morgagni-Pierantoni Hospital,AUSL Romagna,Forlì47121,Italy [2]Department of Medical and Surgical Sciences,University of Bologna,Bologna 40126,Italy

出　　处：《World Journal of Clinical Cases》2022年第24期8556-8567,共12页世界临床病例杂志

摘　　要：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.

关 键 词：CHOLECYSTITIS GALLSTONES CHOLEDOCHOLITHOTOMY Elderly Post-operative complications 

分 类 号：R657.4[医药卫生—外科学]