Gallstone-Related Disease in the Elderly: Is There Room for Improvement?
Background and Aim Elderly patients are frequently affected by gallstone-related disease. Current guidelines support cholecystectomy after a first acute biliary complication. In the aging, these recommendations are irregularly followed. Methods We analyzed data from patients 65 or older admitted between June 30, 2004 and June 30, 2013 with a diagnosis of acute pancreatitis, cholangitis, or cholecystitis. Diagnosis and severity assessment were defined according to current guidelines. Harms, mortality, and cholecystectomy rates were evaluated. Baseline factors independently predicting cholecystectomy were identified. Results A total of 491 patients were included. The median age was 78.8 years, and 51.7 % were women. Acute cholecystitis was present in 51.7 %, acute pancreatitis in 36.5 %, and acute cholangitis in 11.8 %. Cholecystectomy was performed in 47.1 %. Age, myocardial infarct, dementia, diabetes, nonmetastatic tumor, and severe liver disease were risk factors for not undergoing surgery. Complications related to hospital stay appeared in 33 % of patients. Surgery, cholecystostomy, and ERCP presented harms in 21–25 %. Overall mortality rate was 5.4 %: 10.4 % in acute cholangitis, 6.8 % in acute cholecystitis, and 2.2 % in acute pancreatitis. Mild cases presented a 1.3 % mortality, while 28.6 % of severe cases died. After discharge, 24.7 % of patients presented a new biliary complication, 9.7 % of them severe. Relapse was more frequent in patients managed without invasive procedures, 42.3 % than in cholecystectomy patients, 9.9 % (p < 0.001) and than in ERCP patients, 19.4 % (p = 0.01). Conclusions Cholecystectomy should be recommended to elderly patients after a first acute biliary complication. If not previously performed, ERCP should be offered as an alternative when surgery is contraindicated or refused..
| Medienart: |
Artikel |
|---|
| Erscheinungsjahr: |
2015 |
|---|---|
| Erschienen: |
2015 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:60 |
|---|---|
| Enthalten in: |
Digestive diseases and sciences - 60(2015), 6 vom: 11. Jan., Seite 1770-1777 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
García-Alonso, Francisco Javier [VerfasserIn] |
|---|
| Links: |
Volltext [lizenzpflichtig] |
|---|
| Themen: |
|---|
| Anmerkungen: |
© Springer Science+Business Media New York 2015 |
|---|
| doi: |
10.1007/s10620-014-3497-4 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
OLC2027240438 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | OLC2027240438 | ||
| 003 | DE-627 | ||
| 005 | 20230517083015.0 | ||
| 007 | tu | ||
| 008 | 200819s2015 xx ||||| 00| ||eng c | ||
| 024 | 7 | |a 10.1007/s10620-014-3497-4 |2 doi | |
| 035 | |a (DE-627)OLC2027240438 | ||
| 035 | |a (DE-He213)s10620-014-3497-4-p | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 082 | 0 | 4 | |a 610 |q VZ |
| 100 | 1 | |a García-Alonso, Francisco Javier |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Gallstone-Related Disease in the Elderly: Is There Room for Improvement? |
| 264 | 1 | |c 2015 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ohne Hilfsmittel zu benutzen |b n |2 rdamedia | ||
| 338 | |a Band |b nc |2 rdacarrier | ||
| 500 | |a © Springer Science+Business Media New York 2015 | ||
| 520 | |a Background and Aim Elderly patients are frequently affected by gallstone-related disease. Current guidelines support cholecystectomy after a first acute biliary complication. In the aging, these recommendations are irregularly followed. Methods We analyzed data from patients 65 or older admitted between June 30, 2004 and June 30, 2013 with a diagnosis of acute pancreatitis, cholangitis, or cholecystitis. Diagnosis and severity assessment were defined according to current guidelines. Harms, mortality, and cholecystectomy rates were evaluated. Baseline factors independently predicting cholecystectomy were identified. Results A total of 491 patients were included. The median age was 78.8 years, and 51.7 % were women. Acute cholecystitis was present in 51.7 %, acute pancreatitis in 36.5 %, and acute cholangitis in 11.8 %. Cholecystectomy was performed in 47.1 %. Age, myocardial infarct, dementia, diabetes, nonmetastatic tumor, and severe liver disease were risk factors for not undergoing surgery. Complications related to hospital stay appeared in 33 % of patients. Surgery, cholecystostomy, and ERCP presented harms in 21–25 %. Overall mortality rate was 5.4 %: 10.4 % in acute cholangitis, 6.8 % in acute cholecystitis, and 2.2 % in acute pancreatitis. Mild cases presented a 1.3 % mortality, while 28.6 % of severe cases died. After discharge, 24.7 % of patients presented a new biliary complication, 9.7 % of them severe. Relapse was more frequent in patients managed without invasive procedures, 42.3 % than in cholecystectomy patients, 9.9 % (p < 0.001) and than in ERCP patients, 19.4 % (p = 0.01). Conclusions Cholecystectomy should be recommended to elderly patients after a first acute biliary complication. If not previously performed, ERCP should be offered as an alternative when surgery is contraindicated or refused. | ||
| 650 | 4 | |a Aged | |
| 650 | 4 | |a Gallstones | |
| 650 | 4 | |a Cholecystitis, Acute | |
| 650 | 4 | |a Cholecystectomy | |
| 700 | 1 | |a de Lucas Gallego, María |4 aut | |
| 700 | 1 | |a Bonillo Cambrodón, Daniel |4 aut | |
| 700 | 1 | |a Algaba, Alicia |4 aut | |
| 700 | 1 | |a de la Poza, Gema |4 aut | |
| 700 | 1 | |a Martín-Mateos, Rosa María |4 aut | |
| 700 | 1 | |a Bermejo, Fernando |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Digestive diseases and sciences |d Springer US, 1979 |g 60(2015), 6 vom: 11. Jan., Seite 1770-1777 |w (DE-627)129894036 |w (DE-600)304250-9 |w (DE-576)015213218 |x 0163-2116 |7 nnns |
| 773 | 1 | 8 | |g volume:60 |g year:2015 |g number:6 |g day:11 |g month:01 |g pages:1770-1777 |
| 856 | 4 | 1 | |u https://doi.org/10.1007/s10620-014-3497-4 |z lizenzpflichtig |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a SYSFLAG_A | ||
| 912 | |a GBV_OLC | ||
| 912 | |a SSG-OLC-PHA | ||
| 912 | |a SSG-OLC-DE-84 | ||
| 912 | |a GBV_ILN_4012 | ||
| 912 | |a GBV_ILN_4219 | ||
| 912 | |a GBV_ILN_4305 | ||
| 951 | |a AR | ||
| 952 | |d 60 |j 2015 |e 6 |b 11 |c 01 |h 1770-1777 | ||