Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly

Background: A study was conducted to determine whether extremely elderly pa tients, age 80 years or older, were at higher risk for adverse outcomes fro m laparoscopic cholecystectomy than patients younger than 80 years. Methods: Laparoscopic cholecystectomy was attempted in 421 patients age 65 years or older from 1989 through 1999. The patients were divided into two g roups: group 1 (age 65-79 years; n = 351) and group 2 (age, 80-95 years; n = 70). A prospective database was analyzed for mean +/- standard deviation and using Student's t-test and chi-square analysis. Results: Advanced age (group 2) was associated with a higher mean American Society of Anesthesiology (ASA) class (2.7 vs 2.3; p < 0.001) and a greater incidence of common bile duct stones (43% vs 26%; p < 0.01), as compared w ith those of younger age (group 1). Mean operative times in group 2 were 10 6 +/- 45 min as compared with 96 +/- 38 min in group 1, a difference that i s not significant. The extremely elderly (group 2) had a four-fold higher r ate of conversion to open cholecystectomy (16% vs 4%) and a longer mean pos toperative hospital stay (2.1 vs 1.4 days). Grades 1 and 2 complications al so were more common in group 2: grade 1:group 1, 8.8% vs group 2, 17% and g rade 2: group 1, 4.3% vs group 2, 7.1% (p < 0.05). One patient in group 1 h ad a myocardial infarction 13 days postoperatively, and two deaths occurred in the extremely elderly group within 30 days postoperatively. Conclusions: Laparoscopic cholecystectomy in the extremely elderly is assoc iated with more complications and a higher rate of conversion to open chole cystectomy than in elderly individuals younger than 80 years. The greater c hance of encountering a severely inflamed or scarred gallbladder and common bile duct stones as well as increasing comorbidities likely account for th ese differences in outcome.