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Impact of preoperative management in patients older than 80 years requiring cholecystectomy
Ann Hepatobiliary Pancreat Surg 2018 Nov;22(4):380-5
Published online November 30, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

Da-Kyum Shin1, Seok-Hwan Kim1,2, Deok-Bog Moon1, Shin Hwang1, Ki-Hum Kim1, Chul-Soo Ahn1, Tae-Yong Ha1, Gi-Won Song1, Dong-Hwan Jung1, Ki-Byung Song3, Dae-Wook Hwang3, Song-Cheol Kim3, Young-Joo Lee3

1Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 2Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chungnam National University Hospital, Chungnam National University of College of Medicine, Daejeon, 3Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Received August 18, 2018; Revised October 22, 2018; Accepted October 23, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Backgrounds/Aims: Elderly patients aged >80 yr have high morbidity and mortality rates after biliary surgery, especially in emergency operations. We conducted this study to determine the effect of preoperative management on the outcome of elderly patients undergoing cholecystectomy. 
Methods: The medical records of 452 elderly (≥80 yr old) patients who underwent cholecystectomy from January 1997 to December 2015 were reviewed retrospectively. We divided the patients into 2 groups: intervention (preoperative biliary drainage) and non-intervention groups. We evaluated the effects of preoperative management on the American Society of Anesthesiology (ASA) score and perioperative outcomes. 
Results: Among the preoperative biliary drainage intervention group (n=286), 48 patients (51.7%) were diagnosed as having gallbladder stone combined with common bile duct stone. On admission, the proportion of patients with ASA score ≥3 and WBC counts were significantly higher in the intervention group than in the non-intervention group (p<0.05). The preoperative hospital stay was longer in the intervention group; however, operation-related factors such as operation type, time, conversion rate, complications, and mortality showed no difference between groups. 
Conclusions: With proper preoperative evaluations and preoperative biliary drainage, cholecystectomy can be a safe treatment option for elderly patients with cholelithiasis.
Keywords : Aged; Cholecystectomy; Preoperative care; ASA score

 

November 2018, 22 (4)