• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Geriatric Surgery: Impact of Age on the Operative Decision in Gallstone Disease

Introduction: Elderly patients with gallstone disease often present and are treated differently than their younger counterparts. We hypothesize that these differences also exist within age subgroups of elderly patients. The purpose of this study is to evaluate the relationship between age and disease severity and management of gallstone disease, and to identify the predictors of performing a cholecystectomy.

Methods: This is a single institution retrospective chart review of hospital visits for patients ≥65 with biliary colic, cholecystitis, choledocholithiasis, cholangitis, or biliary pancreatitis, between April 2004 and April 2008. All prior visits for these patients were also reviewed. Disease severity outcomes were diagnosis (colic vs. complicated) at first visit, visit type (emergency department (ED) visit only vs. urgent admission vs. elective admission) and clinical severity score (calculated upon presentation to ED and based on temperature, pulse, BP, WBC, and symptom duration). Management outcomes were occurrence of cholecystectomy, occurrence of cholecystostomy tube, and admitting ward at first visit. Stratified age groups (Group 1: 65-75, Group 2: 75-85, and Group 3: ≥85) were compared using Mantel-Haenszel for proportions. Multivariable logistic regression was used to identify predictors of undergoing cholecystectomy.

Results: 433 patients over 622 hospital visits were included in the analysis. Mean Charlson Comorbidity Index (CCI) for Group 1 (n=203), Group 2 (n=169), and Group 3 (n=61) were 1.5±1.8, 2.2±2.1, and 2.3±1.9, respectively. Disease severity: At first visit, diagnosis was complicated disease in 34.0%, 63.1%, and 70.5% of patients (p<0.0001). 33.5% of group 1 visits represented urgent admissions, increasing to 63.7% and 75.4% in groups 2 and 3. The clinical severity score was 1.1±1.0, 1.4±1.1, and 1.6±1.2 for Groups 1, 2, and 3. Management: Over all visits, cholecystectomy was performed in 90.9% in Group 1, 65.4% in Group 2, and 24.7% in Group 3 (p<0.0001) with equivalent proportions of conversion to open (11.5%, 9.4%, 7.1%). Despite multiple visits, the cumulative incidence of operative management reached early plateaus in the older age groups (figure). Cholecystostomy tubes were used in 3.9%, 12.4%, and 16.4% of Group 1, 2, and 3 patients, respectively. The admitting ward was medical for 7.9% of patients in Group 1, 25.6% in Group 2 and 45.9% in Group 3. Patients who were older (OR=0.18, CI=0.11-0.30), with a complicated diagnosis (OR=0.12, CI=0.07-0.19), and higher CCI (OR=0.75, CI=0.67-0.85) were less likely to have a cholecystectomy.

Conclusion: Older age was associated with more severe gallstone disease and a higher likelihood of non-operative management. Age and diagnosis severity were strongly associated with the decision to perform a cholecystectomy. Comorbidity was also predictive, but to a lesser degree. Whether such different treatment strategies are justified for this population should be questioned by comparing the outcomes of operative and non-operative management.


Session: Podium Presentation

Program Number: S019

61

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2010 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons