Which octogenarian patients are at higher risk after cholecystectomy for symptomatic gallstone disease? A single center cohort study

Table 1 Patients’ characteristics and their comparison according to the occurrence of postoperative complications

Variables	Total cohort (n = 269)	Uncomplicated (n = 76)	Complicated (n = 193)	P value
Age	83	83 (82-85)	83 (82-87)	0.686
Sex (M:F)	126:143	344:200	92:101	0.686
ASA
1	1 (0.0)	0	1 (0.5)	0.002
2	62 (23.0)	27 (35.5)	35 (18.1)
3	179 (66.5)	48 (63.2)	131 (67.9)
4	27 (10.0)	1(1.3)	26 (13.5)
BMI	24.8 (24-25.1)	26.3 (22.9-28.2)	24.2 (21.1-27.4)	0.062
Charlson comorbidity index	3 (1-4)	3 (2-4)	2 (1-4)	0.145
Prior upper abdomen surgery	34 (12.6)	11 (32.3)	23 (67.7)	0.548
Leucocytes (× 109/L)	11685 (10520-12957)	9300 (7315-13917)	12850 (8020-18200)	0.009
Platelets (× 109/L)	236 (183-352)	197 (165-262)	272 (189-340)	< 0.0001
Bilirubin (mg/dL)	1.01 (0.58-1.91)	0.82 (0.41-1.53)	1.11 (0.62-2.1)	0.011
C-reactive protein (mg/L)	82 (19.7-225)	46.4 (9-184.6)	85.7 (22.2-231.0)	0.135
Antiplatelet	110 (40.9)	28 (36.8)	82 (42.5)	0.412
Anticoagulant therapy	64 (23.8)	12 (15.8)	52 (26.9)	0.057
Acute cholecystitis Tokyo grade				0.147
Mild	36 (20.1)	11(14.5)	25 (13)
Moderate	75 (42.0)	18 (23.7)	57 (29.6)
Severe	68 (37.9)	10 (13.2)	58 (30.0)
Diagnosis at admission in urgency				0.374
A.C.	69 (38.5)	19 (27.6)	50 (72.4)
A.C. + cholangitis	19 (10.6)	1 (5.2)	18 (94.8)
A.C. + choleperitoneum	25 (14.0)	5 (20)	20 (80)
A.C. + biliary colic	38 (21.2)	9 (23.7)	29 (76.3)
A.C. + biliary pancreatitis	28 (15.7)	7 (25)	21(75)
Preoperative ERCP	23 (8.6)	11 (14.5)	12 (6.2)	0.053
Admission-surgery interval	1 (0-2)	1 (0-2)	1 (0-3)	0.051
Operative time (min)	100 (73-141)	90 (66-120)	105 (75-150)	0.021
Surgical approach				0.012
Laparoscopy		53	115
Open		6 (7.9)	46 (23.8)
Converted to open		17 (23.4)	32(16.6)
Intraoperative cholangiography	161 (58.9)	35 (46.1)	126 (65.3)	0.0005
Choledocholithotomy	15 (5.6)	4 (5.3)	11 (5.7)	1
Transcystic biliary decompression	22 (8.2)	3 (3.9)	19 (9.8)	0.147
Intraoperative ERCP	28 (10.4)	6 (7.9)	22 (11.4)	0.508
Afternoon night-procedure	117 (43.5)	24 (31.6)	93(48.2)	0.014
Length of hospital stay	5 (3-8)	3 (2-6)	6 (4-9)	< 0.0001
Supported discharge	47 (17.5)	9 (11.9)	38 (19.7)	0.154

ASA: American Society of Anesthesiologists; BMI: Body mass index; A.C.: Acute cholecystitis; ERCP: Endoscopic retrograde cholangio-pancreatography.

Table 2 Detailed postoperative complications according to the Clavien Dindo scale

	Election	Urgency
Grade 1	31	54
Nausea and vomiting	18	6
Pain	13	48
Grade 2	19	59
Pneumonia	6	13
Mild pancreatitis	0	7
Ileus-delayed flatus	5	16
Septic status	0	12
Urinary problems	8	11
Grade 3	3	13
Bile leak	0	3
Cholangitis/retained CBD stone	1	6
Bleeding	1	3
Respiratory failure	1	1
Grade 4	0	10
Acute myocardial infarction	0	1
Arrhythmia	0	3
Respiratory failure	0	2
Acute renal failure	0	4
Grade 5	0	4
Acute myocardial infarction	0	3
Pulmonary failure	0	1

CBD: Common bile duct.

Table 3 Univariate and multivariate analysis for postoperative complications

Variables	Univariate analysis	P value	Multivariate analysis	P value
	OR (95%CI)		OR (95%CI)
Age	1.00 (0.93-1.08)	0.864
Sex	0.85 (0.50-1.46)	0.562
ASA
1	NA	NA
2	0.51 (0.28-0.93)	0.027
3	Ref.	1
4	9.53 (1.26-72.1)	0.029
BMI	0.92 (0.85-1.01)	0.072
CCI	0.82 (0.43-1.60	0.611
Prior upper abdomen surgery	0.79 (0.36-1.72)	0.559
Leucocytes	1.00 (1.00-1.00)	0.009
Platelets	1.00 (1.00-1.00)	0.013	1.00 (1.00-1.00)	0.0008
Bilirubin	1.23 (0.97-1.57)	0.081
C-reactive protein	1.00 (0.99-1.00)	0.195
Antiplatelet	1.33 (0.77-2.31)	0.311
Anticoagulant therapy	1.922 (0.96-3.85)	0.065
Acute cholecystitis Tokyo grade
Mild	1.55 (0.67-3.35)	0.324
Moderate	2.19 (1.11-4.32)	0.023
Severe	4.54 (2.00-10.3)	0.0003
BIliary colic	3.43 (1.70-6.93)	0.0006
Biliary pancreatitis	1.24 (0.51-3.04)	0.635
Gallbladder cancer	1.95 (0.22-17.1)	0.543
Choleperitoneum	1.61 (0.58-4.45)	0.36
Cholangitis	12.0 (1.59-89.7)	0.019	12.7 (1.61-100.1)	0.016
Preoperative ERCP	0.38 (0.16-0.91)	0.03
Admission-surgery interval	1.04 (0.95-1.14)	0.326
Laparoscopy	0.28 (0.11-0.69)	0.005	0.10 (0.02-0.46)	0.003
Conversion to open surgery	1.81 (0.37-1.42)	0.354
Choledocholithotomy	1.07 (0.33-3.46)	0.914
Intraoperative cholangiography	2.12 (1.23-3.64)	0.007	2.99 (1.43-6.24)	0.003
Intraoperative ERCP	1.47 (0.57-3.78)	0.423
Transcystic biliary decompression	2.57 (0.73-8.95)	0.138
Afternoon night procedure	2.12 (1.21-3.74)	0.009

ASA: American Society of Anesthesiologists; BMI: Body mass index; ERCP: Endoscopic retrograde cholangio-pancreatography; CCI: Charlson comorbidity index; NA: Not available.

Table 4 Univariate and multivariate analysis for postoperative complications with Clavien-Dindo grade > 2

Variables	Univariate analysis	P value	Multivariate analysis	P value
	OR (95%CI)		OR (95%CI)
Age	1.08 (0.98-1.18)	0.122
Sex	0.64 (0.30-1.38)	0.255
ASA
1	NA
2	0.14 (0.02-1-12)	0.064
3	Ref.	1
4	6.14 (2.48-15.3)	0.001	12.6 (4.27-37.3)	< 0.0001
BMI	1.12 (1.00-1.26)	0.05
CCI	1.19 (0.87-4.21)	0.237
Prior upper abdomen surgery	1.92 (0.72-5.12)	0.193
Leucocytes	1.00 (1.00-1.01)	0.021
Platelets	1.00 (1.00-1.00)	0.545
Bilirubin	1.37 (0.44-4.28)	0.014	1.41 (1.33-1.75)	0.002
C-reactive protein	1.00 (0.99-1.01)	0.252
Antiplatelet	0.96 (0.44-2.08)	0.916
Anticoagulant therapy	2.03 (0.91-4.53)	0.083
Acute cholecystitis Tokyo grade
Mild	3.33 (0.71-15.7)	0.128
Moderate	3.38 (0.86-13.2)	0.08
Severe	8.02 (2.21-29.0)	0.001
Biliary colic	0.79 (0.33-1.87)	0.599
Biliary pancreatitis	0.26 (0.03-1.98)	0.194
Choleperitoneum	2.89 (1.05-7.95)	0.039
Cholangitis	1.37 (0.44-4.28)	0.579
Preoperative ERCP	0.74 (0.16-3.33)	0.696
Admission-surgery interval	1.05 (0.99-1.11)	0.115
Laparoscopy	0.18 (0.08-0.40)	< 0.001
Conversion to open surgery	1.81 (0.75-4.35)	0.185
Choledocholithotomy	4.58 (1.45-14.5)	0.009	10.2 (2.04-51.1)	0.005
Transcystic biliary decompression	5.81 (2.20-15.4)	0.0004
Intraoperative cholangiography	0.86 (0.40-1.86)	0.706
Intraoperative ERCP	1.38 (0.44-4.28)	0.579
Afternoon night procedure	1.82 (0.84-3.91)	0.126

ASA: American Society of Anesthesiologists; BMI: Body mass index; ERCP: Endoscopic retrograde cholangio-pancreatography; CCI: Charlson comorbidity index; NA: Not available.