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Non-operative management of acute cholecystitis in the elderly

McGillicuddy, E. A. ; Schuster, K. M. ; Barre, K. ; Suarez, L. ; Hall, M. R. ; Kaml, G. J. ; Davis, K. A. ; Longo, W. E.

British journal of surgery, 2012-09, Vol.99 (9), p.1254-1261 [Periódico revisado por pares]

Chichester, UK: John Wiley & Sons, Ltd

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Título:
Non-operative management of acute cholecystitis in the elderly
Autor: McGillicuddy, E. A. ; Schuster, K. M. ; Barre, K. ; Suarez, L. ; Hall, M. R. ; Kaml, G. J. ; Davis, K. A. ; Longo, W. E.
Assuntos: Aged ; Anti-Bacterial Agents - administration & dosage ; Anti-Bacterial Agents - therapeutic use ; Biological and medical sciences ; Cholecystectomy, Laparoscopic - statistics & numerical data ; Cholecystitis, Acute - drug therapy ; Cholecystitis, Acute - surgery ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; General aspects ; Humans ; Infusions, Parenteral ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Other diseases. Semiology ; Postoperative Complications - etiology ; Recurrence ; Retrospective Studies ; Risk Factors ; Treatment Outcome
É parte de: British journal of surgery, 2012-09, Vol.99 (9), p.1254-1261
Notas: Presented to the 91st Annual Meeting of the New England Surgical Society, Saratoga Springs, New York, USA, October 2010
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Descrição: Background: Although cholecystectomy is the standard therapy for acute cholecystitis (AC), operative morbidity in the elderly may be high owing to medical co‐morbidities and decreased physiological reserve. Outcomes of AC in the elderly have not been fully defined with regard to operative and long‐term non‐operative management. Methods: Patients aged 65 years or over admitted to a tertiary care centre with a diagnosis of AC between January 2000 and December 2009 were reviewed retrospectively. Patient data, operative and postoperative details were obtained. To determine cholecystectomy rates in the non‐operative group, medical records were reviewed, and patients and families were interviewed. Results: A total of 290 patients underwent cholecystectomy during the index admission, of whom 59 (20·3 per cent) required conversion to open operation. Fifty‐eight of these patients experienced 98 complications, including acute respiratory failure (27), pneumonia (18), myocardial infarction (16) and sepsis (15). Some 185 patients had non‐operative treatment, of whom 67 underwent percutaneous cholecystostomy. Forty‐four patients subsequently had elective cholecystectomy, with a complication rate of 23 per cent. One hundred and twenty‐six patients were discharged without a plan for cholecystectomy; the rate of recurrent AC was 4 per cent among the two‐thirds of patients followed to within 15 months of death. No deaths or major complications occurred among those with recurrent AC. Conclusion: Despite selection of the best elderly candidates for cholecystectomy, postoperative morbidity was significant. Medical management, with interval cholecystectomy only for recurrent AC, may be appropriate in selected patients. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. To be confimed
Editor: Chichester, UK: John Wiley & Sons, Ltd
Idioma: Inglês

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Non-operative management of acute cholecystitis in the elderly

McGillicuddy, E. A. ; Schuster, K. M. ; Barre, K. ; Suarez, L. ; Hall, M. R. ; Kaml, G. J. ; Davis, K. A. ; Longo, W. E.

Chichester, UK: John Wiley & Sons, Ltd

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