Safety of Outpatient Laparoscopic Cholecystectomy in the Elderly: Analysis of 15,248 Patients Using the NSQIP Database
Rao A, Polanco A, Qiu S, et al
J Am Coll Surg. 2013;217:1038-1043
Summary
Is ambulatory cholecystectomy safe for patients who are older than 65 years of age? The authors used information in the American College of Surgeon's quality improvement program to compare 7499 ambulatory vs 7799 nonambulatory patients. Predictably, patients selected for ambulatory surgery were less likely to have heart disease or an underlying bleeding disorder and had a better American Society of Anesthesiologists classification. Overall mortality in the ambulatory group was 0.2%.
Viewpoint
This informative study that was based on a large sample of patients proves that ambulatory cholecystectomy can be safely performed in carefully selected elderly patients. The mortality rate was low, and major complications were extremely rare. Preoperative patient selection contributed to the low mortality rate, with the presence of heart disease or a bleeding disorder being especially important. The authors were unable to include any information on conversion of laparoscopic to open procedures. Surgeons should note that the study results are based mostly on data from academic centers and larger hospitals. The results might be different if based on other hospital types.
Abstract