Published online Apr 27, 2021. doi: 10.4254/wjh.v13.i4.456
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
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.
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.
Our primary outcomes are in-hospital mortality, 30-d mortality and 90-d mortality. Secondary outcome is morbidity (length of hospital stay).
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.
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).
Mortality is indifferent in the elderly (≥ 80 years old) and non-elderly patients (< 80 years old) with AC.
Age alone may not predict the outcomes of AC and its use in the Tokyo Guidelines should be re-evaluated.