Frail geriatric patients with acute calculous cholecystitis: Operative versus nonoperative management?
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ therapeutic use
Cholecystectomy
/ statistics & numerical data
Cholecystitis, Acute
/ etiology
Cholelithiasis
/ complications
Databases, Factual
Drainage
/ methods
Female
Frail Elderly
Humans
Length of Stay
/ statistics & numerical data
Male
Mortality
/ trends
Multivariate Analysis
Patient Readmission
/ statistics & numerical data
Survival Analysis
Treatment Failure
United States
/ epidemiology
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
pubmed:
20
2
2021
medline:
24
9
2021
entrez:
19
2
2021
Statut:
ppublish
Résumé
Nonoperative management of acute calculous cholecystitis (ACC) in the frail geriatric population is underexplored. The aim of our study was to examine long-term outcomes of frail geriatric patients with ACC treated with cholecystectomy compared with initial nonoperative management. We conducted a 2017 analysis of the Nationwide Readmissions Database and included frail geriatric (≥65 years) patients with ACC. Frailty was assessed using the five-factor modified frailty index. Patients were stratified into those undergoing cholecystectomy at index admission (operative management [OP]) versus those managed with nonoperative intervention (nonoperative management [NOP]). The NOP group was further subdivided into those who received antibiotics only and those who received percutaneous drainage. Primary outcomes were procedure-related complications in the OP group and 6-month failure of NOP (readmission with cholecystitis). Secondary outcomes were mortality and overall hospital length of stay. A total of 53,412 geriatric patients with ACC were identified, 51.0% of whom were frail: 16,791 (61.6%) in OP group and 10,472 (38.4%) in NOP group (3,256 had percutaneous drainage, 7,216 received antibiotics only). Patients were comparable in age (76 ± 7 vs. 77 ± 8 years; p = 0.082) and modified frailty index (0.47 vs. 0.48; p = 0.132). Procedure-related complications in the OP group were 9.3%, and 6-month failure of NOP was 18.9%. Median time to failure of NOP management was 36 days (range, 12-78 days). Mortality was higher in the frail NOP group (5.2 vs. 3.2%; p < 0.001). The NOP group had more days of hospitalization (8 [4-15] vs. 5 [3-10]; p < 0.001). Both receiving antibiotics only (odds ratio, 1.6 [1.3-2.0]; p < 0.001) and receiving percutaneous drainage (odds ratio, 1.9 [1.7-2.2]; p < 0.001) were independently associated with increased mortality. One in five patients failed NOP and subsequently had complicated hospital stays. Nonoperative management of frail elderly ACC patients may be associated with significant morbidity and mortality. Therapeutic, level IV.
Identifiants
pubmed: 33605704
doi: 10.1097/TA.0000000000003115
pii: 01586154-202107000-00032
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
219-225Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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