D'Acapito F, Solaini L, Di Pietrantonio D, Tauceri F, Mirarchi MT, Antelmi E, Flamini F, Amato A, Framarini M, Ercolani G. Which octogenarian patients are at higher risk after cholecystectomy for symptomatic gallstone disease? A single center cohort study. World J Clin Cases 2022; 10(24): 8556-8567 [PMID: 36157828 DOI: 10.12998/wjcc.v10.i24.8556]
Corresponding Author of This Article
Leonardo Solaini, MD, Assistant Professor, Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy. leonardo.solaini2@unibo.it
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 26, 2022; 10(24): 8556-8567 Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8556
Which octogenarian patients are at higher risk after cholecystectomy for symptomatic gallstone disease? A single center cohort study
Fabrizio D'Acapito, Leonardo Solaini, Daniela Di Pietrantonio, Francesca Tauceri, Maria Teresa Mirarchi, Elena Antelmi, Francesca Flamini, Alessio Amato, Massimo Framarini, Giorgio Ercolani
Fabrizio D'Acapito, Leonardo Solaini, Daniela Di Pietrantonio, Francesca Tauceri, Maria Teresa Mirarchi, Elena Antelmi, Francesca Flamini, Alessio Amato, Massimo Framarini, Giorgio Ercolani, Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì 47121, Italy
Leonardo Solaini, Giorgio Ercolani, Department of Medical and Surgical Sciences, University of Bologna, Bologna 40126, Italy
Author contributions: All authors contributed to the study conception and design; Material preparation, data collection and analysis were performed by D’Acapito F, Solaini L, Di Pietrantonio D, Tauceri F, Mirarchi MT, Antelmi E , Flamini F, Amato A, Frmarini M and Ercolani G; The first draft of the manuscript was written by D’Acapito F, Solaini L and Ercolani G; All authors commented on previous versions of the manuscript, read and approved the final manuscript; and D’Acapito F and Solaini L contributed equally to this paper.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of ROMAGNA CEROM (10/04/2019) (Approval No. 3238/2019 I.5/263).
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The datasets generated during and/or analyzed during the current study are not publicly available due privacy policies but are available from the corresponding author on reasonable request.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Leonardo Solaini, MD, Assistant Professor, Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy. leonardo.solaini2@unibo.it
Received: April 27, 2022 Peer-review started: April 27, 2022 First decision: May 30, 2022 Revised: June 13, 2022 Accepted: July 22, 2022 Article in press: July 22, 2022 Published online: August 26, 2022 Processing time: 110 Days and 17.5 Hours
Abstract
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.
Core Tip: The incidence of gallstone disease is high in octogenarian patients. There are no contraindications in performing cholecystectomy in this population, however, they may be at higher risk of complications. Herein, we will analyze perioperative variables to understand their impact on postoperative courses. Then, we will construct a model in order to help in the selection of patients aged > 80 years who need cholecystectomy.
