Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta-analysis
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and Other Interventional Techniques
REVIEW ARTICLE
Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta‑analysis Sivesh K. Kamarajah1,2 · Santhosh Karri3 · James R. Bundred3 · Richard P. T. Evans4,5 · Aaron Lin3 · Tania Kew3 · Chinenye Ekeozor3 · Susan L. Powell6 · Pritam Singh7,8 · Ewen A. Griffiths4,5 Received: 12 April 2020 / Accepted: 25 June 2020 © The Author(s) 2020
Abstract Background Laparoscopic cholecystectomy is increasingly performed in an ever ageing population; however, the risks are poorly quantified. The study aims to review the current evidence to quantify further the postoperative risk of cholecystectomy in the elderly population compared to younger patients. Method A systematic literature search of PubMed, EMBASE and the Cochrane Library databases were conducted including studies reporting laparoscopic cholecystectomy in the elderly population. A meta-analysis was reported in accordance with the recommendations of the Cochrane Library and PRISMA guidelines. Primary outcome was overall complications and secondary outcomes were conversion to open surgery, bile leaks, postoperative mortality and length of stay. Results This review identified 99 studies incorporating 326,517 patients. Increasing age was significantly associated with increased rates of overall complications (OR 2.37, CI95% 2.00–2.78), major complication (OR 1.79, CI95% 1.45–2.20), risk of conversion to open cholecystectomy (OR 2.17, CI95% 1.84–2.55), risk of bile leaks (OR 1.50, C I95% 1.07–2.10), risk of postoperative mortality (OR 7.20, CI95% 4.41–11.73) and was significantly associated with increased length of stay (MD 2.21 days, CI95% 1.24–3.18). Conclusion Postoperative outcomes such as overall and major complications appear to be significantly higher in all age cutoffs in this meta-analysis. This study demonstrated there is a sevenfold increase in perioperative mortality which increases by tenfold in patients > 80 years old. This study appears to confirm preconceived suspicions of higher risks in elderly patients undergoing cholecystectomy and may aid treatment planning and informed consent. Keywords Cholecystectomy · Elderly · Outcomes · Laparoscopic Over 66,000 cholecystectomies are performed each year in the UK costing over £110 million to the National Health Service [1, 2]. The majority of these cases are now done laparoscopically, owing to significantly lower rates of morbidity and mortality compared to conventional open Sivesh K. Kamarajah and Santhosh Karri have contributed equally as co-first authors. James R. Bundred and Richard P. T. Evans have contributed equally as co-second authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-07805-z) contains supplementary material, which is available to authorised users. * Ewen A. Griffiths [email protected] Extended author information available on the last page of the article
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