Relationships of age, cholecystectomy approach and timing with the surgical and functional outcomes of elderly patients with cholecystitis

Background: Safety confirmation has led to calls for laparoscopic cholecystectomy (LC) to prevail in elderly patients, but the functional changes after LC have not been sufficiently compared with open cholecystectomy (OC). Using an administrative database, we reassessed the quality of cholecystectomy approach and timing of cholecystectomy for elderly patients with cholecystitis. Methods: A total of 2552 patients aged ≥60 years who underwent cholecystectomy for cholecystitis were enrolled. Variables included demographics, comorbidities, complications, preoperative bile duct scrutiny, cholecystectomy timing (<48, 48-96, >96 h), functional status estimated by the Barthel index, teaching status, postoperative length of stay (LOS) and total charges (TC). The impacts of age, OC and timing on LOS, TC, complications and functional changes were assessed by mixed linear regression analyses using propensity score-matched cohorts for LC and OC. Results: The patients comprised 1742 LC and 810 OC patients across 122 hospitals. The mean ages and octogenarian proportions were 70.1 years and 10.6% for LC and 72.9 years and 20.5% for OC. Advancing age, males and acute inflammation were more frequently associated with OC. Longer LOS, higher TC and more complications were observed for OC. Age was a predictor of functional changes but not complications. Octogenarians and complications were associated with longer LOS, higher TC and more functional deterioration. Earlier cholecystectomy was only associated with lower TC. Conclusions: Octogenarians were likely to have OC and functional deterioration. Since OC was a predictor of resource use and complications, strategies to complete earlier LC and prevent complications are required for octogenarians.