Background: Accrued comorbidities are perceived to increase operative risk. Surgeons may offer operative treatments less often to their older patients with acute complicated calculous biliary disease (ACCBD). We set out to capture ACCBD incidence in older patients across Europe and the currently used treatment algorithms. Methods: The European Society of Trauma and Emergency Surgery (ESTES) undertook a snapshot audit of patients undergoing emergency hospital admission for ACCBD between October 1 and 31 2018, comparing patients under and C 65 years. Mortality, postoperative complications, time to operative intervention, post-acute disposition, and length of hospital stay (LOS) were compared between groups. Within the C 65 cohort, comorbidity burden,mortality, LOS, and disposition outcomes were further compared between patients undergoing operative and non-operative management. Results: The median age of the 338 admitted patients was 67 years; 185 patients (54.7%) of these were the age of 65 or over. Significantly fewer patients C 65 underwent surgical treatment (37.8% vs. 64.7%, p\0.001). Surgical complications were more frequent in the C 65 cohort than younger patients, and the mean postoperative LOS was significantly longer. Postoperative mortality was seen in 2.2% of patients C 65 (vs. 0.7%, p = 0.253). However, operated elderly patients did not differ from non-operated in terms of comorbidity burden, mortality, LOS, or postdischarge rehabilitation need. Conclusions: Few elderly patients receive surgical treatment for ACCBD. Expectedly, postoperative morbidity, LOS, and the requirement for post-discharge rehabilitation are higher in the elderly than younger patients but do not differ from elderly patients managed non-operatively. With multidisciplinary perioperative optimization, elderly patients may be safely offered optimal treatment. Trial Registration ClinicalTrials.gov (Trial # NCT03610308).

Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently - Results and Insights from the ESTES Snapshot Audit

Nicolo de Manzini
Membro del Collaboration Group
;
Alan Biloslavo
Membro del Collaboration Group
;
Davide Cosola
Membro del Collaboration Group
;
Stefano Fracon
2021

Abstract

Background: Accrued comorbidities are perceived to increase operative risk. Surgeons may offer operative treatments less often to their older patients with acute complicated calculous biliary disease (ACCBD). We set out to capture ACCBD incidence in older patients across Europe and the currently used treatment algorithms. Methods: The European Society of Trauma and Emergency Surgery (ESTES) undertook a snapshot audit of patients undergoing emergency hospital admission for ACCBD between October 1 and 31 2018, comparing patients under and C 65 years. Mortality, postoperative complications, time to operative intervention, post-acute disposition, and length of hospital stay (LOS) were compared between groups. Within the C 65 cohort, comorbidity burden,mortality, LOS, and disposition outcomes were further compared between patients undergoing operative and non-operative management. Results: The median age of the 338 admitted patients was 67 years; 185 patients (54.7%) of these were the age of 65 or over. Significantly fewer patients C 65 underwent surgical treatment (37.8% vs. 64.7%, p\0.001). Surgical complications were more frequent in the C 65 cohort than younger patients, and the mean postoperative LOS was significantly longer. Postoperative mortality was seen in 2.2% of patients C 65 (vs. 0.7%, p = 0.253). However, operated elderly patients did not differ from non-operated in terms of comorbidity burden, mortality, LOS, or postdischarge rehabilitation need. Conclusions: Few elderly patients receive surgical treatment for ACCBD. Expectedly, postoperative morbidity, LOS, and the requirement for post-discharge rehabilitation are higher in the elderly than younger patients but do not differ from elderly patients managed non-operatively. With multidisciplinary perioperative optimization, elderly patients may be safely offered optimal treatment. Trial Registration ClinicalTrials.gov (Trial # NCT03610308).
Pubblicato
https://link.springer.com/article/10.1007/s00268-021-06052-0
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154793/
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11368/3027551
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