Laparoscopic vs open approach for acute cholecystitis in octogenarians. A prospective multicenter observational nationwide study

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola Pub Date : 2025-01-01 DOI:10.1016/j.ciresp.2024.06.006

N. Lluís , C. Villodre , P. Zapater , M. Cantó , L. Mena , J.M. Ramia , F. Lluís , on behalf of the LUCENTUM Project Collaborative Group

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Abstract

Background

The world population is aging, with octogenarians expected to reach over 400 million by 2050. Acute cholecystitis is a serious complication in the elderly. Age is not a contraindication for emergency cholecystectomy, an option that can both save lives and preserve quality of life.

Methods

The present study aimed to compare open and laparoscopic surgical approaches. Over six months, 38 emergency surgery units enrolled all consecutive octogenarians with acute cholecystitis undergoing cholecystectomy. Postoperative outcomes were compared after propensity score matching analysis.

Results

The study included 212 patients (84 years [81–86], 47.2% women). The open approach was used in 32.1% of patients, and the laparoscopic approach in 67.9%. After propensity score matching, a decrease in hospital stays (open, 8 days [6–13]; laparoscopic, 5 days [4–8]; P < .001), 30-day morbidity (open, 48.5%; laparoscopic, 26.5%; P = .01), and 30-day mortality (open, 13.2%, laparoscopic, 1.5%; P = .02) was found. Among the specific postoperative complications, a decrease in septicemia (open, 14.7%; laparoscopic, 0%; P = .001) was observed.

Conclusions

Laparoscopic approach was used in two out of three octogenarians. After propensity score matching, octogenarians undergoing laparoscopic approach had shorter length of hospital stay, fewer 30-day postoperative complications, fewer episodes of septicemia, and less 30-day mortality than octogenarians undergoing open approach. These findings suggest that the laparoscopic approach may be the preferred choice for octogenarians with acute cholecystitis undergoing cholecystectomy.

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80岁老人急性胆囊炎的腹腔镜与开放入路比较。一项前瞻性全国多中心观察性研究

世界人口正在老龄化，预计到2050年，80多岁的老人将超过4亿。急性胆囊炎是老年人的一种严重并发症。年龄不是紧急胆囊切除术的禁忌症，这是一种既能挽救生命又能保持生活质量的选择。方法本研究旨在比较开放和腹腔镜手术入路。在6个月的时间里，38个急诊外科单位招募了所有连续接受胆囊切除术的80多岁急性胆囊炎患者。倾向评分匹配分析后比较术后结果。结果共纳入212例患者（84岁[81-86]，女性占47.2%）。32.1%的患者采用开放入路，67.9%的患者采用腹腔镜入路。倾向评分匹配后，住院时间减少(开放，8天[6-13]；腹腔镜，5天[4-8]；P < .001)， 30天患病率(open, 48.5%；腹腔镜,26.5%;P = 0.01)， 30天死亡率(开放，13.2%，腹腔镜，1.5%；P = .02)。在特定的术后并发症中，败血症(open, 14.7%；腹腔镜,0%;P = .001)。结论3例八旬老人中2例采用腹腔镜入路治疗。倾向评分匹配后，腹腔镜入路八十岁老人住院时间短，术后30天并发症少，败血症发作少，30天死亡率低于开放入路八十岁老人。这些发现提示腹腔镜方法可能是八十多岁急性胆囊炎行胆囊切除术的首选方法。

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

Cirugia Espanola SURGERY-

CiteScore

1.20

自引率

21.10%

发文量

173

审稿时长

53 days

期刊介绍： Cirugía Española, an official body of the Asociación Española de Cirujanos (Spanish Association of Surgeons), will consider original articles, reviews, editorials, special articles, scientific letters, letters to the editor, and medical images for publication; all of these will be submitted to an anonymous external peer review process. There is also the possibility of accepting book reviews of recent publications related to General and Digestive Surgery.