Department of Surgery, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Pavilion A-515, 3755 Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.
Surg Endosc. 2011 Jan;25(1):55-61. doi: 10.1007/s00464-010-1128-5. Epub 2010 May 29.
This study aimed to describe the differences in the management of symptomatic gallstone disease within different elderly groups and to evaluate the association between older age and surgical treatment.
This single-institution retrospective chart review included all patients 65 years old and older with an initial hospital visit for symptomatic gallstone disease between 2004 and 2008. The patients were stratified into three age groups: group 1 (age, 65-74 years), group 2 (age, 75-84 years), and group 3 (age, ≥ 85 years). Patient characteristics and presentation at the initial hospital visit were described as well as the surgical and other nonoperative interventions occurring over a 1-year follow-up period. Logistic regression was performed to assess the effect of age on surgery.
Data from 397 patient charts were assessed: 182 in group 1, 160 in group 2, and 55 in group 3. Cholecystitis was the most common diagnosis in groups 1 and 2, whereas cholangitis was the most common diagnosis in group 3. Elective admissions to a surgical ward were most common in group 1, whereas urgent admissions to a medical ward were most common in group 3. Elective surgery was performed at the first visit for 50.6% of group 1, for 25.6% of group 2, and for 12.7% of group 3, with a 1-year cumulative incidence of surgery of 87.4% in group 1, 63.5% in group 2, and 22.1% in group 3. Inversely, cholecystostomy and endoscopic retrograde cholangiopancreatography (ERCP) were used more often in the older groups. Increased age (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.84-0.91) and the Charlson Comorbidity Index (OR, 0.80; 95% CI, 0.69-0.94) were significantly associated with a decreased probability of undergoing surgery within 1 year after the initial visit.
Even in the elderly population, older patients presented more frequently with severe disease and underwent more conservative treatment strategies. Older age was independently associated with a lower likelihood of surgery.
本研究旨在描述不同老年人群中症状性胆石病的管理差异，并评估年龄与手术治疗之间的关系。
本单中心回顾性病历研究纳入了 2004 年至 2008 年间因症状性胆石病初次就诊且年龄≥65 岁的所有患者。患者被分为三组：第 1 组（年龄 65-74 岁）、第 2 组（年龄 75-84 岁）和第 3 组（年龄≥85 岁）。描述了患者的特征和初次就诊时的表现，以及在 1 年随访期间发生的手术和其他非手术干预措施。采用 logistic 回归评估年龄对手术的影响。
共评估了 397 份患者病历：第 1 组 182 例，第 2 组 160 例，第 3 组 55 例。第 1 组和第 2 组最常见的诊断为胆囊炎，第 3 组最常见的诊断为胆管炎。第 1 组最常见的是择期转入外科病房，第 3 组最常见的是紧急转入内科病房。第 1 组初次就诊时即行择期手术的比例为 50.6%，第 2 组为 25.6%，第 3 组为 12.7%，第 1 组 1 年内手术累积发生率为 87.4%，第 2 组为 63.5%，第 3 组为 22.1%。相反，胆囊造口术和内镜逆行胰胆管造影术（ERCP）在年龄较大的组中更为常用。高龄（比值比 [OR]，0.87；95%置信区间 [CI]，0.84-0.91）和 Charlson 合并症指数（OR，0.80；95%CI，0.69-0.94）与初次就诊后 1 年内手术的可能性降低显著相关。
即使在老年人群中，高龄患者也更常出现严重疾病，并接受更保守的治疗策略。年龄较大与手术可能性降低独立相关。
