Impact of age on outcomes and hospital costs of urgent laparoscopic cholecystectomy for acute cholecystitis: a retrospective cohort study.

Abstract

Background: This study aimed to compare the clinical outcomes and hospital costs between younger and older adult with acute cholecystitis patients who received urgent laparoscopic cholecystectomy.

Methods: A 3-year retrospective study was conducted. Patients admitted to surgical units for urgent laparoscopic cholecystectomy at Chi-Mei Hospital from January 1, 2019, to December 31, 2021, were included. Patients' baseline data were collected from medical records review. Postoperative complications are defined by the Clavien-Dindo classification as being greater than grade I. Total costs during admission were also collected based on disease-related groups (DRG system).

Results: Among 300 patients selected, 68.3% (n = 205) were aged < 60 years, 19.3% (n = 58) were aged between 60 and 69 years, and 12.3% (n = 37) were aged ≥ 70 years. Patients aged ≥ 70 years had higher rates of comorbidities, higher ASA levels, and lower platelet counts than those in patients aged < 60 years. After adjusting for possible confounders in the multivariable models, older age was significantly associated with longer hospital stays (length of stay, or LOS) (β = 0.56 for patients aged 60-69 years and 1.30 for those aged ≥ 70 years) and correspondingly higher hospital costs (β = 219.69 for patients aged 60-69 years and 302.48 for ≥ 70 years) compared to those for patients aged < 60 years. No significant associations were found between older age and the occurrence of postoperative complications.

Conclusions: Urgent LC with adequate perioperative care is feasible for treating acute cholecystitis in older adult patients. Older age is independently associated with longer LOS and higher costs but not with short-term postoperative complications.