Frailty predicts outcome of elective laparoscopic cholecystectomy in geriatric patients
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and Other Interventional Techniques
Frailty predicts outcome of elective laparoscopic cholecystectomy in geriatric patients Konstantinos Lasithiotakis • John Petrakis • Maria Venianaki • George Georgiades Dimosthenis Koutsomanolis • Alexander Andreou • Odysseas Zoras • George Chalkiadakis
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Received: 17 February 2012 / Accepted: 23 August 2012 / Published online: 9 October 2012 Ó Springer Science+Business Media, LLC 2012
Abstract Background Frailty is a phenotype characterized by complex and challenging medical problems and higher susceptibility to adverse health outcomes. It can be derived at by a multidimensional process known as comprehensive geriatric assessment (CGA), which assesses the functional reserves of the elderly. In this study we report for the first time on a prospective evaluation of the association between CGA and postoperative complications after elective laparoscopic cholecystectomy for biliary disease. Methods Fifty-seven patients older than 65 years who were to undergo elective laparoscopic cholecystectomy for uncomplicated biliary disease were prospectively examined. Preoperative CGA was performed and the patients were categorized as fit or frail. The main outcome of the study was the rate of any postoperative complication within 30 days of surgery. Results There were 29 women (50.9 %) and the median (interquartile range) age of the cohort was 73 (8.8) years. Thirty-two patients (56.1 %) were categorized as frail and 25 (43.9 %) as fit. The overall incidence of postoperative complications was 23.7 %, most of which were grade I and II (18.8 %). Frail patients, according to the CGA assessment, experienced a significantly higher incidence of postoperative complications compared to their fit counterparts (84.6 vs. 15.4 %, p = 0.023). Frail patients experienced a significantly higher frequency of prolonged (more
K. Lasithiotakis (&) J. Petrakis M. Venianaki G. Georgiades D. Koutsomanolis A. Andreou O. Zoras G. Chalkiadakis Department of General Surgery, Heraklion University Hospital, 71110 Heraklion, Crete, Greece e-mail: [email protected]
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than 2 days) postoperative hospital stay compared with their fit counterparts (p = 0.023). Conclusions Preoperative CGA may predict postoperative complications and prolonged postoperative hospital stay of elderly patients who undergo elective laparoscopic cholecystectomy. Larger-scale studies independently assessing this association are warranted. Keywords Frailty Comprehensive geriatric assessment Laparoscopic cholecystectomy Postoperative complications
The world population is in the midst of an unprecedented demographic transformation characterized by rapid expansion of older-age groups mainly in industrialized areas such as Europe, North America, Oceania, and Japan. It is estimated that until 2050, almost 33 % of the population will be over 65 years old [1]. Urgent adaptation of our current health-care system in order to serve the new demographic reality is necessary. Toward this end and given the increased incidence of postop
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