Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2021; 13(4): 456-471
Published online Apr 27, 2021. doi: 10.4254/wjh.v13.i4.456
Elderly patients (≥ 80 years) with acute calculous cholangitis have similar outcomes as non-elderly patients (< 80 years): Propensity score-matched analysis
Kai Siang Chan, Ramkumar Mohan, Jee Keem Low, Sameer P Junnarkar, Cheong Wei Terence Huey, Vishal G Shelat
Kai Siang Chan, Jee Keem Low, Sameer P Junnarkar, Cheong Wei Terence Huey, Vishal G Shelat, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Kai Siang Chan, MOH Holdings, Singapore 099253, Singapore
Ramkumar Mohan, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Author contributions: Chan KS contributed data interpretation and analysis, drafting of the article and approval of the final version of article to be published; Mohan R contributed data acquisition, drafting of article and approval of the final version of the article to be published; Low JK, Junnarkar SP, Huey CWT contributed study design, data acquisition, manuscript review and approval of the final version of the article to be published; Shelat VG contributed study conception and design, critical revision of the manuscript and approval of final version of article to be published.
Institutional review board statement: Our local institutional review board approved this study (National Healthcare Group Domain Specific Review Board, approval No. 2017/00200).
Informed consent statement: This study was conducted using data collected from an institutional board approved standing database (National Healthcare Group Domain Specific Review Board, Ref No.: 2017/00200). Informed consent was hence not obtained from the included patients. Collected data were de-identified and were only accessible to members of the study team with no subsequent patient contact for data collection purposes. The study team made no attempts to access patients' medical records via the national electronic health record system.
Conflict-of-interest statement: All of the authors declare no conflicts of interest.
Data sharing statement: The data used in this study is not publicly available due to institutional policies. However, requests may be made to the corresponding author for access to de-identified data.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Vishal G Shelat, DNB, FRCS, MBBS, MS, Adjunct Professor, Doctor, Surgeon, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
Received: January 3, 2021
Peer-review started: January 3, 2021
First decision: January 25, 2021
Revised: February 6, 2021
Accepted: March 24, 2021
Article in press: March 24, 2021
Published online: April 27, 2021
Research background

Acute cholangitis (AC) is a disease spectrum with varying extent of severity. Age ≥ 75 years forms part of the criteria for moderate (Grade II) severity in the Tokyo Guidelines (TG13 and TG18). Aging is associated with reduced physiological reserves, frailty, and sarcopenia. However, there is evidence that age itself is not the determinant of inferior outcomes in elective and emergency biliary diseases.

Research motivation

Endoscopic retrograde cholangiopancreatography is deemed to be safe in elderly patients with AC. There is paucity of data on outcome determinants in elderly patients with AC. This era of ageing population prompted our interest to study the impact of age alone on outcomes of AC through the use of propensity score matching.

Research objectives

Our primary outcomes are in-hospital mortality, 30-d mortality and 90-d mortality. Secondary outcome is morbidity (length of hospital stay).

Research methods

This is a single-center retrospective cohort study of all patients diagnosed with calculous AC (January 2016 to December 2016) and ≥ 80 years old (January 2012 to December 2016) at a tertiary university-affiliated teaching hospital. Elderly was defined as ≥ 80 years old while non-elderly was defined as < 80 years old.

Research results

Four hundred fifty-seven patients with AC were included in this study (318 elderly, 139 non-elderly). Propensity score matching analysis resulted in a total of 224 patients (112 elderly, 112 non-elderly). The overall in-hospital mortality, 30-d mortality and 90-d mortality were 4.6%, 7.4% and 8.5% respectively, with no statistically significant differences between the elderly and non-elderly in both the unmatched and matched cohorts. Length of hospital stay was longer in the unmatched cohort [elderly 8 d, interquartile range (IQR) 6-13 vs non-elderly 8 d, IQR 5-11, P = 0.040], but was comparable in the matched cohort (elderly 7.5 d, IQR 5-11 vs non-elderly 8 d, IQR 5-11, P = 0.982).

Research conclusions

Mortality is indifferent in the elderly (≥ 80 years old) and non-elderly patients (< 80 years old) with AC.

Research perspectives

Age alone may not predict the outcomes of AC and its use in the Tokyo Guidelines should be re-evaluated.