Evaluation of the surgical management strategy for acute cholecystitis in patients over 75 years old

IF 2 4区医学 Q2 SURGERY

Journal of Visceral Surgery Pub Date : 2024-10-01 DOI:10.1016/j.jviscsurg.2024.06.009

Xavier Giraud , Laetitia Geronimi-Robelin , Martin M. Bertrand , Ariane Bell

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引用次数: 0

Abstract

Introduction

Acute cholecystitis occurs frequently in the elderly. According to the current recommendations specific to the characteristics of each case, these patients are most often treated by delayed cholecystectomy after medical treatment. Our study aimed to compare the success rate of this strategy in patients over and under 75 years of age.

Patients and methods

This was a retrospective single-center analytic observational study that included patients who were hospitalized for acute cholecystitis in a geriatric postoperative unit (unité postopératoire gériatrique [UPOG]) and gastrointestinal surgery unit between 2021 and 2022. The main endpoint was the failure rate of deferred cholecystectomy. Secondary endpoints included: respect for the recommended operative delay, loss of the patient's functional independence during hospitalization, and the reason for surgical abstention.

Results

In total, 290 patients were included. The strategy of delayed elective cholecystectomy was not achieved in 31 (44%) patients 75 years old or older vs. eight (18%) patients younger than 75 years old (P = 0.005). The main reason was the decision not to operate after medical treatment. In both groups, the recommended operative interval was equitably respected and the loss of autonomy during hospitalization was minor. More than one-third of the elderly patients scheduled for elective surgery finally refused to undergo surgery.

Conclusion

The strategy of routine elective cholecystectomy should not be strict in the elderly with acute cholecystitis; the indication for this procedure should take into account the wishes as well as the physiological status of the patient.

查看原文本刊更多论文

评估 75 岁以上患者急性胆囊炎的手术治疗策略。

导言：急性胆囊炎经常发生在老年人身上。根据目前针对每个病例特点提出的建议，这些患者通常在接受药物治疗后采用延迟胆囊切除术。我们的研究旨在比较这一策略在 75 岁以上和 75 岁以下患者中的成功率：这是一项回顾性单中心分析观察研究，纳入了2021年至2022年间因急性胆囊炎在老年术后病房（unité postopératoire gériatrique [UPOG]）和胃肠外科病房住院的患者。主要终点是延期胆囊切除术的失败率。次要终点包括：遵守建议的手术延迟时间、住院期间患者功能独立性的丧失以及放弃手术的原因：结果：共纳入 290 名患者。31名（44%）75岁及以上的患者与8名（18%）75岁以下的患者相比（P=0.005），没有实现延迟选择性胆囊切除术的策略。主要原因是药物治疗后决定不进行手术。在两组患者中，建议的手术间隔时间都得到了公平的遵守，住院期间自主权的损失也很小。超过三分之一的老年患者最终拒绝接受择期手术：结论：对于患有急性胆囊炎的老年人，常规选择性胆囊切除术的策略不应过于严格；手术指征应考虑患者的意愿和生理状况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Visceral Surgery SURGERY-

CiteScore

2.00

自引率

9.50%

发文量

108

审稿时长

>12 weeks

期刊介绍： The Journal of Visceral Surgery (JVS) is the online-only, English version of the French Journal de Chirurgie Viscérale. The journal focuses on clinical research and continuing education, and publishes original and review articles related to general surgery, as well as press reviews of recently published major international works. High-quality illustrations of surgical techniques, images and videos serve as support for clinical evaluation and practice optimization. JVS is indexed in the main international databases (including Medline) and is accessible worldwide through ScienceDirect and ClinicalKey.