Mo1575 Cost-Effectiveness of Elective Cholecystectomy vs. Observation in Older Patients Presenting With Mild Biliary Disease

Cholelithiasis is extremely common in the United States, affecting approximately 10 to 15% of the population. The vast majority of patients remain asymptomatic. Elective cholecystectomy for symptomatic cholelithiasis is a well-established procedure with excellent outcomes. The diagnosis in critically ill patients may not be straightforward. Inflammation and infection of the gallbladder can lead to significant morbidity and mortality. Whether the gallbladder is the primary etiology of hemodynamic compromise (as in emphysematous or gangrenous cholecystitis) or is the victim of secondary insult (as in ischemia-related acalculous cholecystitis), the intensivist must consider cholecystitis in the differential of clinical deterioration. This review contains 6 figures, 5 tables, and 59 references. Key words: acalculous, biliary disease, cholangitis, cholecystitis, emphysematous cholecystitis

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Bile Duct Stones Predict a Requirement for Cholecystectomy in Older Patients

World Journal of Surgery ◽

10.1007/s00268-019-05241-2 ◽

2019 ◽

Vol 44 (3) ◽

pp. 721-729 ◽

Cited By ~ 1

Author(s):

Yoichi Matsui ◽

Satoshi Hirooka ◽

Tatsuma Sakaguchi ◽

Masaya Kotsuka ◽

So Yamaki ◽

...

Keyword(s):

Bile Duct ◽

Older Patients ◽

Bile Duct Stone ◽

Elective Surgery ◽

Gallstone Disease ◽

Therapeutic Options ◽

Bile Duct Stones ◽

History Of ◽

Wait And See ◽

Elective Cholecystectomy

Abstract Background The requirement for elective cholecystectomy in older patients is unclear. To determine predictors for requiring elective cholecystectomy in older patients, a prospective cohort study was performed. Methods All patients with gallstone disease who presented to our department from 2006 to 2018 were included if they met the following criteria: (1) age 75 years or older, (2) presentation for elective cholecystectomy, and (3) preoperative diagnosis of cholecystolithiasis. Two therapeutic options, elective surgery and a wait-and-see approach, were offered at their initial visit. Enrolled patients were assigned to one arm of the study according to their choice of the therapeutic options. The primary endpoint was the incidence of gallstone-related complications. The endpoint was compared between patients who underwent cholecystectomy (CH group) and those who chose a wait-and-see approach (No-CH group). Results During the study period, there were 344 patients in the CH group and 161 in the No-CH group. Among patients with a history of bile duct stones, the incidence of gallstone-related complications in the No-CH group was significantly higher (45% within 3 years, including two gallstone-related deaths) than that in the CH group (RR 2.66, 95% confidence interval 1.50–4.77, p = 0.0009). Among patients with no history of bile duct stones, the incidence of gallstone-related complications in the No-CH group reached only 10% over the 12 years. Conclusion Cholecystectomy is recommended for older patients with both histories of cholecystolithiasis and bile duct stones, whereas a wait-and-see approach is preferable for patients with no bile duct stone history. A history of bile duct stones is a good predictor for cholecystectomy in older patients.

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Correction: Cost-Effectiveness of Statins in Older Patients with Myocardial Infarction

Annals of Internal Medicine ◽

10.7326/0003-4819-136-8-200204160-00023 ◽

2002 ◽

Vol 136 (8) ◽

pp. 635 ◽

Cited By ~ 3

Author(s):

David A. Ganz ◽

Karen M. Kuntz ◽

Joshua S. Benner ◽

Jerry Avorn

Keyword(s):

Myocardial Infarction ◽

Cost Effectiveness ◽

Older Patients

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Cost Effectiveness of an Aromatase Inhibitor and Recombinant FSH Versus FSH Alone in Older Patients Undergoing Intrauterine Insemination

Fertility and Sterility ◽

10.1016/j.fertnstert.2005.07.101 ◽

2005 ◽

Vol 84 ◽

pp. S42 ◽

Cited By ~ 2

Author(s):

M.A. Bedaiwy ◽

R. Forman ◽

R.F. Casper

Keyword(s):

Cost Effectiveness ◽

Aromatase Inhibitor ◽

Older Patients ◽

Intrauterine Insemination ◽

Recombinant Fsh

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Cost-effectiveness of a follow-up program for older patients with heart failure: a randomized controlled trial

European Geriatric Medicine ◽

10.1007/s41999-018-0074-y ◽

2018 ◽

Vol 9 (4) ◽

pp. 523-532 ◽

Cited By ~ 2

Author(s):

José L. González-Guerrero ◽

Miguel A. Hernández-Mocholi ◽

José M. Ribera-Casado ◽

Nieves García-Mayolín ◽

Teresa Alonso-Fernández ◽

...

Keyword(s):

Heart Failure ◽

Randomized Controlled Trial ◽

Cost Effectiveness ◽

Older Patients ◽

Controlled Trial ◽

Randomized Controlled ◽

Patients With Heart Failure

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Cost-Effectiveness of 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitor Therapy in Older Patients with Myocardial Infarction

Annals of Internal Medicine ◽

10.7326/0003-4819-132-10-200005160-00003 ◽

2000 ◽

Vol 132 (10) ◽

pp. 780 ◽

Cited By ~ 63

Author(s):

David A. Ganz ◽

Karen M. Kuntz ◽

Gretchen A. Jacobson ◽

Jerry Avorn

Keyword(s):

Myocardial Infarction ◽

Cost Effectiveness ◽

Older Patients ◽

Reductase Inhibitor ◽

Coenzyme A ◽

Inhibitor Therapy ◽

Coenzyme A Reductase

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The Risk Paradox: Use of Elective Cholecystectomy in Older Patients Is Independent of Their Risk of Developing Complications

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2014.12.012 ◽

2015 ◽

Vol 220 (4) ◽

pp. 682-690 ◽

Cited By ~ 7

Author(s):

Taylor S. Riall ◽

Deepak Adhikari ◽

Abhishek D. Parmar ◽

Suzanne K. Linder ◽

Francesca M. Dimou ◽

...

Keyword(s):

Older Patients ◽

Elective Cholecystectomy

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Differential Management Strategies and Outcomes in Patients over 65 years with Acute Calculous Biliary Disease—Results and Insights from the ESTES Complicated Biliary Calculous Disease Snapshot Audit

10.21203/rs.3.rs-23736/v1 ◽

2020 ◽

Author(s):

Gary Alan Bass ◽

Amy E. Gillis ◽

Yang Cao ◽

Shahin Mohseni ◽

ESTES Cohort Studies Collaborative Group

Keyword(s):

Surgical Treatment ◽

Elderly Patients ◽

Hospital Stay ◽

Older Patients ◽

Operative Mortality ◽

The Elderly ◽

Operative Intervention ◽

Ageing Population ◽

Biliary Disease ◽

Elderly Cohort

Abstract Background: Acute complicated calculous biliary disease (ACCBD) may pose challenges in an ageing population. Frailty and comorbidities increase the potential risks of surgery; thus, surgeons may opt to offer operative treatments less often to their older patients. We set out to capture the incidence and treatment algorithms used across Europe to treat older patients presenting with ACCBD.Methods: Analysis of the European Society of Trauma and Emergency Surgery (ESTES) 2018 Acute Complicated Calculous Biliary Disease audit was performed. Patients undergoing emergency hospital admission with ACCBD between 1 October 2018 and 31 October 2018 were included. The primary outcome measure was operative intervention in patients over and under 65 years of age. Mortalities, post-operative morbidity, time to operative intervention, post-acute disposition and length of hospital stay were measured as secondary outcomes.Results: The median age of the 338 patients admitted to the snapshot was 67 years; 185 patients (54.7%) were over 65 years at time of admission. Significantly fewer patients over 65 underwent definitive surgical treatment, compared with those under 65 (37.8% vs. 64.7%, p <0.001). Surgical complications were seen more frequently in the over 65 cohort. Post-operative mortality was seen in 2.2% of over 65s versus 0.7% under 65(p=0.253). Mean post-operative length of stay was significantly longer in the elderly cohort. In patients surviving to discharge, post-acute convalescence or rehabilitation was required in 13.3% in the elderly cohort versus 1.9% of those under 65 (p=0.002).Conclusions: Elderly patients commonly present with ACCBD. Increased frailty and incidence of comorbid disease in this population increases the potential surgical risk. In our snapshot, elderly patients represented the majority, but far fewer were offered definitive surgical treatment. Post-operative mortality, morbidity, length of post-operative in-hospital stay and the requirement for post-discharge convalescence were higher in this group.

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