Choice of therapeutic approach for acute cholecystitis in the elderly

Abstract

Background: Acute cholecystitis in elderly patients is a common disease characterized by a high mortality rate and serious complications. Aim: To compare conservative vs. surgical therapy for acute cholecystitis in the elderly. Methods: This is a retrospective study including patients 70 years-old or older with the diagnosis of acute cholecystitis (AC) treated between 2003 and 2009. Epidemiological and clinical data, diagnostic approach, surgical variables and cost-effectiveness were analyzed. According to the first therapeutic intent, the analysis was performed among final treatment groups and among older than 80 years and younger cases. p < 0.05 was considered significant. Statistical analysis was performed with StatView© 5.0. Results: During the six-year period 173 episodes of acute cholecystitis were treated on 147 patients (52% females), with a mean age of 80.6 years (range 70-101). In 103 cases medical treatment was taken, with 82 cases of resolution of the clinical picture, 15 unexpected operations and 6 deceases. Other 70 cases were undergone surgery as first option, 78.5% of them through laparoscopy with a conversion rate of 19.7%. Conclusions: In our study, surgery and medical treatment get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy. We recommend performing emergency surgery in high-risk elderly patients rather than conservative therapy due to a tendency to increase morbidity with later approach.