Cao Junning, Liu Bo, Shi Jihang, Meng Xuan, Zhang Hangyu, Pan Yingwei, Lu Shichun
Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China.
ANZ J Surg. 2021 Apr;91(4):597-602. doi: 10.1111/ans.16656. Epub 2021 Feb 18.
This study aims to retrospectively analyse the safety of ambulatory laparoscopic cholecystectomy (ALC) and identify risk factors for delayed discharge after ALC in the elderly.
Consecutive patients who were scheduled to undergo ALC were assigned to the elderly group (age ≥ 65 years) or the non-elderly group. The primary outcome was postoperative discharge within 24 h (D24). Secondary outcomes were perioperative mortality, reasons for delayed discharge (psychosocial reasons (DP), complications (DC), drainage (DD) and conversion to open surgery (DCO)), intraoperative data and readmission within 30 days after discharge (readmission). Differences were statistically significant when P < 0.05.
There were 7657 patients assigned to the elderly group (n = 1143) or the non-elderly group (n = 6514). The differences between elderly patients and non-elderly patients in the operation time (51.0 (37.0-70.0) versus 50.0 (35.0-65.0) min), blood loss (10.0 (5.0-10.0) versus 5.0 (5.0-10.0) mL), D24 (75.5% versus 81.7%) and DD (7.8% versus 3.2%) were statistically significant (P < 0.05, respectively). The differences between elderly patients and non-elderly patients in DP (8.2% versus 6.7%), DC (7.8% versus 7.9%), DCO (0.7% versus 0.5%) and readmission (0.5% versus 0.4%) were not statistically significant (P > 0.05, respectively). Independent risk factors for delayed discharge after ALC in the elderly were male sex, octogenarian status, prolonged operation time, arrhythmia, type 2 diabetes mellitus, a previous operation in the upper abdomen, acute inflammation of gallbladder and a gallbladder wall thicker than 3 mm (P < 0.05, respectively).
ALC in the elderly is feasible and safe.
本研究旨在回顾性分析非住院腹腔镜胆囊切除术（ALC）的安全性，并确定老年患者ALC术后延迟出院的危险因素。
将计划接受ALC的连续患者分为老年组（年龄≥65岁）和非老年组。主要结局是术后24小时内出院（D24）。次要结局包括围手术期死亡率、延迟出院原因（心理社会原因（DP）、并发症（DC）、引流（DD）和转为开放手术（DCO））、术中数据以及出院后30天内再次入院（再入院）。当P<0.05时，差异具有统计学意义。
共有7657例患者被分配到老年组（n = 1143）或非老年组（n = 6514）。老年患者与非老年患者在手术时间（51.0（37.0 - 70.0）对50.0（35.0 - 65.0）分钟）、失血量（10.0（5.0 - 10.0）对5.0（5.0 - 10.0）毫升）、D24（75.5%对81.7%）和DD（7.8%对3.2%）方面的差异具有统计学意义（P分别<0.05）。老年患者与非老年患者在DP（8.2%对6.7%）、DC（7.8%对7.9%）、DCO（0.7%对0.5%）和再入院（0.5%对0.4%）方面的差异无统计学意义（P分别>0.05）。老年患者ALC术后延迟出院的独立危险因素为男性、八十岁以上、手术时间延长、心律失常、2型糖尿病、上腹部既往手术史、胆囊急性炎症和胆囊壁厚度超过3毫米（P分别<0.05）。
老年患者行ALC是可行且安全的。
