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

Gary A Bass, Amy E Gillis, Yang Cao, Shahin Mohseni, European Society for Trauma and Emergency Surgery (ESTES) Cohort Studies Group, Andreas Shamiyeh, Lena Rosetti, Günter Klimbacher, Bettina Klugsberger, Paul Healy, Conor Moriarty, Colm Power, Nauar Knightly, Arnold Dk Hill, Desmond C Winter, Michael E Kelly, Ben E Creavin, Éanna J Ryan, Caoimhe C Duffy, Michael Sugrue, Michael Hugh Moore, Louise Flanagan, Jessica Ryan, Conor Keady, Brian Fahey, Kevin L McKevitt, Kevin Barry, Kevin C Conlon, Keno Mentor, Andrea Kazemi-Nava, Barbara Julies, Paul F Ridgway, Dara O Kavanagh, Mark Donnelly, Cathleen McCarrick, Umair Muhammad, Tara M Connelly, Paul C Neary, Sabina Magalina, Valerio Cozza, Antonio LaGreca, Daniele Gui, Alessia Malagnino, Mauro Zago, Mauro Montuori, Alan Biloslavo, Natasa Samardzic, Stefano Fracon, Davide Cosola, Nicolò de Manzini, Urânia Fernandes, Paulo Avelar, Rita Marques, Ana Sofia Esteves, André Marçal, Carina Gomes, Daniela Machado, Tobias Teles, Sofia Neves, Miguel Semiao, Rui Cunha, Jorge Pereira, Júlio Constantino, Milene Sá, Carlos Casimiro, Lidia Ionescu, Roxana Livadariu, Ludmila Stirbu, Radu Danila, Daniel Timofte, Bogdan Astefaniei, Aitor Landaluce Olavarria, Begoña Estraviz Mateos, Jaime Gonzalez Taranco, David Gomez, Jon Barrutia, Julio Zeballos, Dieter Morales Garcia, Ana Lozano Najera, Erik Gonzalez Tolaretxipi, Luis Tallon-Aguilar, José Pintor-Tortolero, Alejandro Sanchez-Arteaga, Virginia Duran-Muñóz Cruzado, Violeta Camacho-Marente, José Tinoco-Gonzalez, Anna Älverdal, Stefan Redeen, Shahin Mohseni, Ahmad Mohammad Ismail, Rebecka Ahl, Spyros Marinos, Naomi Warner, Rikhil Patel, Tania Magro, Romeshan Sunthareswaran, Andrei Mihailescu, Goran Pokusewski, Al Exandru Leopold Bubuianu, Corneliu Dimitriu, Marius Paraoan, Arjun Desai, Katie Jones, Makhosini Mlotshwa, Kenny Ross, Simon Lambracos, Yegor Tryliskyy, Daniel C Cullinane, Gary A Bass, Amy E Gillis, Yang Cao, Shahin Mohseni, European Society for Trauma and Emergency Surgery (ESTES) Cohort Studies Group, Andreas Shamiyeh, Lena Rosetti, Günter Klimbacher, Bettina Klugsberger, Paul Healy, Conor Moriarty, Colm Power, Nauar Knightly, Arnold Dk Hill, Desmond C Winter, Michael E Kelly, Ben E Creavin, Éanna J Ryan, Caoimhe C Duffy, Michael Sugrue, Michael Hugh Moore, Louise Flanagan, Jessica Ryan, Conor Keady, Brian Fahey, Kevin L McKevitt, Kevin Barry, Kevin C Conlon, Keno Mentor, Andrea Kazemi-Nava, Barbara Julies, Paul F Ridgway, Dara O Kavanagh, Mark Donnelly, Cathleen McCarrick, Umair Muhammad, Tara M Connelly, Paul C Neary, Sabina Magalina, Valerio Cozza, Antonio LaGreca, Daniele Gui, Alessia Malagnino, Mauro Zago, Mauro Montuori, Alan Biloslavo, Natasa Samardzic, Stefano Fracon, Davide Cosola, Nicolò de Manzini, Urânia Fernandes, Paulo Avelar, Rita Marques, Ana Sofia Esteves, André Marçal, Carina Gomes, Daniela Machado, Tobias Teles, Sofia Neves, Miguel Semiao, Rui Cunha, Jorge Pereira, Júlio Constantino, Milene Sá, Carlos Casimiro, Lidia Ionescu, Roxana Livadariu, Ludmila Stirbu, Radu Danila, Daniel Timofte, Bogdan Astefaniei, Aitor Landaluce Olavarria, Begoña Estraviz Mateos, Jaime Gonzalez Taranco, David Gomez, Jon Barrutia, Julio Zeballos, Dieter Morales Garcia, Ana Lozano Najera, Erik Gonzalez Tolaretxipi, Luis Tallon-Aguilar, José Pintor-Tortolero, Alejandro Sanchez-Arteaga, Virginia Duran-Muñóz Cruzado, Violeta Camacho-Marente, José Tinoco-Gonzalez, Anna Älverdal, Stefan Redeen, Shahin Mohseni, Ahmad Mohammad Ismail, Rebecka Ahl, Spyros Marinos, Naomi Warner, Rikhil Patel, Tania Magro, Romeshan Sunthareswaran, Andrei Mihailescu, Goran Pokusewski, Al Exandru Leopold Bubuianu, Corneliu Dimitriu, Marius Paraoan, Arjun Desai, Katie Jones, Makhosini Mlotshwa, Kenny Ross, Simon Lambracos, Yegor Tryliskyy, Daniel C Cullinane

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 ≥ 65 years. Mortality, postoperative complications, time to operative intervention, post-acute disposition, and length of hospital stay (LOS) were compared between groups. Within the ≥ 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 ≥ 65 underwent surgical treatment (37.8% vs. 64.7%, p < 0.001). Surgical complications were more frequent in the ≥ 65 cohort than younger patients, and the mean postoperative LOS was significantly longer. Postoperative mortality was seen in 2.2% of patients ≥ 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 post-discharge 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).

Conflict of interest statement

The authors declare no conflicts of interest.

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Source: PubMed

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