Non-operative management of acute cholecystitis in the elderly

Br J Surg. 2012 Sep;99(9):1254-61. doi: 10.1002/bjs.8836. Epub 2012 Jul 24.

Abstract

Background: Although cholecystectomy is the standard therapy for acute cholecystitis (AC), operative morbidity in the elderly may be high owing to medical co-morbidities and decreased physiological reserve. Outcomes of AC in the elderly have not been fully defined with regard to operative and long-term non-operative management.

Methods: Patients aged 65 years or over admitted to a tertiary care centre with a diagnosis of AC between January 2000 and December 2009 were reviewed retrospectively. Patient data, operative and postoperative details were obtained. To determine cholecystectomy rates in the non-operative group, medical records were reviewed, and patients and families were interviewed.

Results: A total of 290 patients underwent cholecystectomy during the index admission, of whom 59 (20·3 per cent) required conversion to open operation. Fifty-eight of these patients experienced 98 complications, including acute respiratory failure (27), pneumonia (18), myocardial infarction (16) and sepsis (15). Some 185 patients had non-operative treatment, of whom 67 underwent percutaneous cholecystostomy. Forty-four patients subsequently had elective cholecystectomy, with a complication rate of 23 per cent. One hundred and twenty-six patients were discharged without a plan for cholecystectomy; the rate of recurrent AC was 4 per cent among the two-thirds of patients followed to within 15 months of death. No deaths or major complications occurred among those with recurrent AC.

Conclusion: Despite selection of the best elderly candidates for cholecystectomy, postoperative morbidity was significant. Medical management, with interval cholecystectomy only for recurrent AC, may be appropriate in selected patients.

MeSH terms

  • Aged
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / therapeutic use
  • Cholecystectomy, Laparoscopic / statistics & numerical data*
  • Cholecystitis, Acute / drug therapy*
  • Cholecystitis, Acute / surgery
  • Female
  • Humans
  • Infusions, Parenteral
  • Male
  • Postoperative Complications / etiology
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents