Is there a difference in textbook outcomes of emergency cholecystectomy in older patients compared with younger patients?

BACKGROUND

Textbook outcome (TO) is a concept that describes achieving an uneventful course for a patient undergoing surgery. It was first described for colorectal surgery and is now increasingly linked to various topics of surgical literature. After the S.P.Ri.M.A.C.C. Study, the authors applied the concept to emergency cholecystectomies. In this study, we aimed to question whether being an older patient commands a difference in textbook outcome rates.

METHODS

All patients undergoing emergency cholecystectomy in a single tertiary hospital between 2020 and 2024 were included in this study. The TO criteria included no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, a hospital stay of ≤ 7 days and complete laparoscopic surgery. Group A included patients younger than 65 years and the others comprised group B.

RESULTS

The study was conducted with 212 patients, of whom 123 (58%) were female. Conversion to open and subtotal cholecystectomy were similar between groups. The textbook outcome rate was 88% in the younger group and 72% in the elderly patients (p = 0.040). However, multivariate logistic regression analyses did not support age as a significant factor in textbook outcome. Length of hospital stay (> 7 days) and postoperative complications were determined to be reasons for not achieving the textbook outcome.

CONCLUSIONS

The textbook outcome rate in older patients was not similar to that in younger patients. Surgical and non-surgical causes should be highlighted. Risk stratification remains important in the management of acute cholecystitis. Larger studies with patient-centred data are needed to improve the concept.