Fuks David, Duhaut Pierre, Mauvais Francois, Pocard Marc, Haccart Vincent, Paquet Jean-Christophe, Millat Bertrand, Msika Simon, Sielezneff Igor, Scotté Michel, Chatelain Denis, Regimbeau Jean Marc
Department of Digestive Surgery, Amiens University Hospital, Amiens, France.
Department of Internal Medicine, Amiens University Hospital, Amiens, France.
J Am Geriatr Soc. 2015 May;63(5):1010-6. doi: 10.1111/jgs.13330. Epub 2015 May 6.
To compare the demographic characteristics and intra- and postoperative outcomes in elderly adults (≥75) with those of younger adults undergoing early (<5 days after onset of complaints) cholecystectomy.
Retrospective analysis from May 2010 to August 2012.
Randomized, multicenter, clinical trial (ABCAL Study, NCT01015417).
Individuals with mild or moderate acute calculous cholecystitis (ACC) according to the Tokyo Guidelines (N=414; n=78 aged 75-94, median 82; n=336 aged 18-74, median 49).
Demographic characteristics and pre-, intra-, and postoperative data.
The elderly group was more likely to have an American Society of Anesthesiologists score of 3 or greater (62% vs 23%, P<.001), higher serum creatinine (103 vs 74 μmol/L, P<.001), and more-severe ACC (moderate ACC (62% vs 50%, P=.05), gangrenous cholecystitis (38% vs 15%, P=.001)) on preoperative imaging and confirmed intraoperatively. Ulcerated mucosa (76% vs 61%, P=.001) was significantly more frequent in the elderly group. Operative time, postoperative mortality, and postoperative infectious (18% vs 14%, P=.35) and noninfectious (9% vs 3%, P=.80) complications were similar between the two groups. Median length of stay (7.0 vs 5.0 days, P=.54) and readmission rate (15% vs 4%, P=.07) were not significantly higher in the elderly group. No significant difference was observed for the subgroup of participants aged 80 and older.
In this randomized trial that included a selected sample of older adults, there was no difference in major outcomes between elderly adults and their younger counterparts after early cholecystectomy. The findings are limited because important geriatric outcomes such as delirium and functional decline were not examined.
比较老年成年人（≥75岁）与接受早期（症状出现后<5天）胆囊切除术的年轻成年人的人口统计学特征以及术中和术后结果。
2010年5月至2012年8月的回顾性分析。
随机、多中心临床试验（ABCAL研究，NCT01015417）。
根据东京指南诊断为轻度或中度急性结石性胆囊炎（ACC）的患者（N = 414；78例年龄在75 - 94岁，中位数82岁；336例年龄在18 - 74岁，中位数49岁）。
人口统计学特征以及术前、术中和术后数据。
老年组患者美国麻醉医师协会（ASA）评分≥3分的可能性更高（62% 对23%，P <.001），血清肌酐水平更高（103对74 μmol/L，P <.001），术前影像学检查及术中确认的重度ACC更常见（中度ACC（62%对50%，P = .05），坏疽性胆囊炎（38%对15%，P = .001））。老年组溃疡黏膜发生率显著更高（76%对61%，P = .001）。两组的手术时间、术后死亡率以及术后感染性（18%对14%，P = .35）和非感染性（9%对3%，P = .80）并发症相似。老年组的中位住院时间（7.0对5.0天，P = .54）和再入院率（15%对4%，P = .07）并无显著更高。80岁及以上参与者亚组未观察到显著差异。
在这项纳入特定老年人群样本的随机试验中，早期胆囊切除术后老年成年人与年轻成年人的主要结局并无差异。由于未检查谵妄和功能衰退等重要的老年结局，研究结果存在局限性。
