Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
Dig Liver Dis. 2021 Dec;53(12):1620-1626. doi: 10.1016/j.dld.2021.01.011. Epub 2021 Jan 23.
Acute cholecystitis (AC) is a life-threatening emergency in elderly patients.
To compare the commonly used management strategies for elderly patients with AC as well as resulting morbidity, mortality and length of hospital stay (LOS).
All patients ≥ 65 years admitted to our emergency department for AC between January 1st, 2014 and December 31st, 2018 were included in the study. We compared patients that received medical treatment to patients who received operative procedures. In order to correct for baseline covariates and factors associated to clinical management, we used a 1:1 propensity score matching (PSM) analysis. The primary outcome was the overall in-hospital mortality. Secondary outcomes included occurrence of major complications and LOS.
A total of 1075 patients were enrolled: 483 patients received a medical treatment and 592 patients underwent interventional procedures. After PSM, 770 patients (385 for each treatment group) were included in the analysis. The analysis revealed that both mortality and cumulative major complications were similar in medical and interventional group. We found that among comorbidities, Charlson comorbidity index and congestive heart failure were significantly higher in the medical treatment group (5 [4-6] vs. 4 [3-6] and 11.7% vs. 4.7%, respectively; p<0.001). LOS was slightly lower in the medical treatment group (7.0 days [4.9-11.1] vs. 7.9 [4.9-13.5]; p = 0.046).
Medical management outcomes for AC in elderly patients were similar to operative treatments in terms of mortality and cumulative major complications. A conservative approach should always be considered.
急性胆囊炎（AC）是老年患者的一种危及生命的紧急情况。
比较老年 AC 患者常用的治疗策略，以及由此产生的发病率、死亡率和住院时间（LOS）。
本研究纳入了 2014 年 1 月 1 日至 2018 年 12 月 31 日期间因 AC 入住我院急诊科的所有≥65 岁的患者。我们比较了接受药物治疗的患者和接受手术治疗的患者。为了校正基线协变量和与临床管理相关的因素，我们使用了 1:1 的倾向评分匹配（PSM）分析。主要结局是总住院死亡率。次要结局包括主要并发症的发生和 LOS。
共纳入 1075 例患者：483 例接受药物治疗，592 例接受介入治疗。PSM 后，770 例患者（每组 385 例）纳入分析。分析结果显示，药物治疗组和介入治疗组的死亡率和累积主要并发症发生率相似。我们发现，在合并症中，Charlson 合并症指数和充血性心力衰竭在药物治疗组中明显更高（5 [4-6] vs. 4 [3-6] 和 11.7% vs. 4.7%，分别；p<0.001）。药物治疗组的 LOS 略低（7.0 天 [4.9-11.1] vs. 7.9 [4.9-13.5]；p=0.046）。
在老年 AC 患者中，药物治疗的结果与手术治疗在死亡率和累积主要并发症方面相似。应始终考虑保守治疗。
