Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA.
Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina.
J Gastrointest Surg. 2019 Mar;23(3):503-509. doi: 10.1007/s11605-018-3863-1. Epub 2018 Sep 17.
Data comparing outcomes following cholecystectomy and cholecystostomy tube placement (CTP) in elderly patients are lacking. We aimed to compare the post-procedural outcomes between cholecystectomy and CTP in elderly patients with acute cholecystitis.
We performed a retrospective, population-based analysis using the National Inpatient Sample for the period 2000-2014. Patients ≥ 65 years old admitted with a primary diagnosis of acute cholecystitis and who underwent either cholecystectomy or CTP during their hospitalization were included. Multivariable linear and logistic regression models were used to analyze post-procedural complications, mortality, length of stay, and total charges. The effect of procedure type on patient outcomes, stratified by acalculous and calculous cholecystitis, was also performed.
A total of 200,915 patients were included, of which 7516 underwent CTP and 193,399 underwent cholecystectomy. The median age of patients undergoing CTP and cholecystectomy was 80 (IQR 73-87) and 75 (IQR 70-81), respectively. Patients undergoing CTP were more likely to have post-procedural infection (OR 2.25; 95% CI 2.07, 2.45), bleeding (OR 1.28; 95% CI 1.19, 1.37), and inpatient mortality (OR 9.27; 95% CI 7.95, 10.81). On average, CTP patients stayed 1.25 days longer (95% CI 1.14, 1.37) in hospital after the procedure. The benefits of cholecystectomy were consistent in patients with acalculous and calculous cholecystitis.
Elderly patients with both acalculous and calculous acute cholecystitis managed with CTP have higher incidences of post-procedural morbidity and mortality, and longer post-procedure length of hospital stay, as compared to cholecystectomy. Unless prohibitive surgical risks exist, elderly patients with acute cholecystitis should undergo cholecystectomy.
缺乏比较老年患者胆囊切除术和胆囊造口术（CTP）术后结果的数据。我们旨在比较老年急性胆囊炎患者行胆囊切除术和 CTP 后的术后结果。
我们使用国家住院患者样本进行了回顾性基于人群的分析，时间范围为 2000-2014 年。纳入年龄≥65 岁，因急性胆囊炎初次入院且在住院期间行胆囊切除术或 CTP 的患者。采用多变量线性和逻辑回归模型分析术后并发症、死亡率、住院时间和总费用。还按无结石和结石性胆囊炎对手术类型对患者结局的影响进行了分层分析。
共纳入 200915 例患者，其中 7516 例行 CTP，193399 例行胆囊切除术。行 CTP 和胆囊切除术的患者中位年龄分别为 80（IQR 73-87）和 75（IQR 70-81）。行 CTP 的患者术后感染（OR 2.25；95%CI 2.07，2.45）、出血（OR 1.28；95%CI 1.19，1.37）和住院期间死亡率（OR 9.27；95%CI 7.95，10.81）更高。平均而言，CTP 患者术后住院时间延长 1.25 天（95%CI 1.14，1.37）。在无结石和结石性胆囊炎患者中，胆囊切除术的益处是一致的。
与胆囊切除术相比，接受 CTP 治疗的老年患者并发术后发病率和死亡率更高，术后住院时间更长，患有急性胆囊炎的老年患者，如果没有明显的手术风险，应行胆囊切除术。
