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
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World J Clin Cases. Aug 26, 2022; 10(24): 8556-8567 Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8556
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
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
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
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
Citation: 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