| Objective: To analyze the therapeutic effect and the safety of day-surgery laparoscopic cholecystectomy (LC/DS) in the elderly.Methods: The 4764 cases of LC/DS having been performed from November 2009 to July 2015 were retrospectively studied. The therapeutic results and reasons for delayed discharge of elderly patients were analyzed. The relationship between clinical data(including gender, age, BMI, operation time, blood loss, previous medical history and gallbladder pathologic findings) and delayed discharge in the elderly was determined.The clinical data (including gender, age, BMI, operation time, blood loss, postoperative hospital stay, incidence of delayed discharge occurred by psychosocial reasons,incidence of delayed discharge occurred by drainage, incidence of complications,incidence of conversion to open surgery and incidence of readmitance within 30 days after discharge) related to elderly patients were compared with that related to non-elderly patients. Differences were statistically significant when p-value < 0.05 level.Results: 710 elderly patients underwent LC/DS. 566 patients (79.7%) were discharged within 24 hours after completion of the operation, and 144 patients (20.3%) were delayed discharge. The reasons for delayed discharge included psychosocial reasons (P,n=61), complications (n=46), drainage (n=31) and conversion to open surgery (CO,n=6). Group P had a shorter length of postoperative hospital stay compared to group complications [2.0 (2.0, 2.0) d vs 2.0 (2.0, 2.0) d,p=0.007], group drainage [2.0(2.0, 2.0) dvs2.0 (2.0, 3.0) d,p<0.001] and group CO [2.0 (2.0, 2.0) d vs 8.5(7.8,21.5) d,p<0.001]. Group drainage had a longer operation time [60.0 (45.0,71.5) min vs 122.0 (110.0,155.0) min,p<0.001; 57.5 (37.3,79.3) min vs 122.0(110.0, 155.0) min,p<0.001] and a more blood loss [10.0 (5.0, 20.0) ml vs 30.0(10.0,50.0) ml,p<0.001; 10.0 (5.0,16.3) ml vs 30.0 (10.0,50.0) ml,P<0.001] compared to groups P and complications. Group CO had a longer operation time[60.0 (45.0, 71.5) min vs 167.5 (129.3, 241.3) min,p<0.001 ; 57.5 (37.3, 79.3)min vs 167.5 (129.3, 241.3) min,p<0.001 ; 122.0 (110.0, 155.0) min vs 167.5(129.3,241.3 ) min,p=0.048] and a longer length of postoperative hospital stay [2.0(2.0, 2.0) d vs 8.5 (7.8, 21.5) d,p<0.001; 2.0 (2.0, 2.0) d vs 8.5 (7.8, 21.5)d,p<0.001; 2.0 (2.0, 3.0) d vs 8.5 (7.8, 21.5) d,p<0.001] compared to groups P, complications and drainage. Independent risk factors related to delayed discharge occurred by psychosocial reasons in the elderly were age (p=0.025), arrhythmia(p=0.016) and chronic inflammation of gallbladder (p< 0.001). Independent risk factors related to delayed discharge occurred by drainage in the elderly were operation time?60 min (p=0.002), blood loss?15 ml (p=0.003), acute inflammation of gallbladder (p=0.001) and thickness of gallbladder wall?3 mm (p=0.016). 4054 non-elderly patients underwent LC/DS. Differences between elderly patients and non-elderly patients regarding operation time [57.5 (41.8, 74.3) mins vs 54.0 (40.0, 70.0)mins,p=0.007], blood loss [10.0 (5.0, 20.0) ml vs 5.0 (0, 10.0) ml, p<0.001],postoperative hospital stay[ 1.0 (1.0, 1.0) d vs 1.0 (1.0, 1.0) d,p<0.001], general incidence of delayed discharge (20.3% vs 14.8%,p<0.001) , incidence of delayed discharge occurred by psychosocial reasons (8.6% vs 6.5%,p=0.040) and incidence of delayed discharge occurred by drainage (4.4% vs 2.0%,p<0.001 )were statistically significant. Differences between elderly patients and non-elderly patients regarding incidence of complications (6.5% vs 5.9%,p=0.563), incidence of conversion to open surgery (0.8% vs 0.4%, p=0.145) and incidence of readmitance within 30 days after discharge (0.7% vs 0.5%,p=0.663) were not statistically significant.Conclusion: Elderly patients who are delayed discharge due to psychosocial reasons have a rapid postoperative recovery. It is reasonable for elderly patients who undergo drainage because of the severe inflammation of the gallbladder or undergo conversion to open surgery because of the impossible laparoscopic surgery to experience a delayed discharge. Independent risk factors related to delayed discharge after LC/DS in the elderly are age, arrhythmia, operation time?60 minutes, blood loss?15 ml, chronic inflammation of gallbladder, acute inflammation of gallbladder and thickness of gallbladder wall?3 mm. The risk of complications, conversion to open surgeries and readmitance in the elderly are not higher than that in the non-elderly. LC/DS in the elderly is safe and feasible. |
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