The role of frailty score in early surgical treatment of elderly cholecystitis patients

Year 2023, Volume: 9 Issue: 1, 108 - 115, 04.01.2023

Nihan Turhan Cengiz Duran Didem Ertorul Ülkü Bulut Batur

https://doi.org/10.18621/eurj.1073632

Cited By: 1

Abstract

Objectives: The average life expectancy is increasing all over the world, and as a result, the number of elderly patients is increasing. Acute cholecystitis is one of the most common diseases requiring emergency surgical treatment in the elderly. In the literature, it has been reported that in the treatment of elderly patients with acute cholecystitis, physicians do not fully comply with the current literature recommendations due to some concerns and do not apply surgical treatment in the early period. The concept of frailty, which has come to the fore in geriatric assessment today, provides objective information about the general health status of the patient. In our study, the role of frailty assessment in the decision made regarding the early surgery in elderly patients with acute cholecystitis treated in our hospital was investigated.

Methods: In our study, the clinical features, comorbidities, American Society of Anesthesiologists (ASA) scores, Canadian Study of Health and Aging (CSHA) frailty scale, treatment modalities and prognosis of patients over the age of 65 who were treated with the diagnosis of acute cholecystitis between January 2018 and January 2021 were evaluated retrospectively.

Results: Of the 182 patients included in the study, 24 (13.2%) were found to be frail. It was observed that the mean age and multi-morbidity were higher in the frail group (p < 0.001). It was observed that the mean C-reactive protein and leukocyte values, which are inflammatory mediators, increased in both groups, both fragile and non-fragile, and complicated cholecystitis accompanied by cholangitis or pancreatitis was observed in a total of 64 (35.16%) patients. There were 57 (31.3%) patients using anticoagulant or antiaggregant agents. The patients were most frequently treated with medical treatment (n = 108; 59.3%), the other treatment methods were early surgery ( (n = 46; 25.3%), endoscopic retrograde cholangiopancreatography (n = 22; 12.1%) and percutaneous cholecystostomy (n = 11; 6.0%). Surgical treatment was more common in ASA I and II patients, and percutaneous cholecystostomy was more common in frail patients (p < 0.001). There were 20 (14.70%) patients who were re-admitted to the hospital and 6 (3.29%) patients ended up with mortality. No statistical relationship could be demonstrated between these conditions and frailty (p > 0.05).

Conclusions: In the treatment of the elderly cholecystitis patients, early surgical treatment is the most favorable treatment method in order to reduce re-admission and prevent possible complications. However, we think that a detailed geriatric evaluation should be made in a multidisciplinary manner for the decision making regarding the of surgical treatment of elderly patients, and frailty evaluation should also be made in this context.

Keywords

Acute cholecystitis, early surgical treatment, frailty, elderly

References

• 1. Pisano M, Ceresoli M, Cimbanassi S, Gurusamy K, Coccolini F, Borzellino G, et al. 2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population. World J Emerg Surg 2019;14:10.
• 2. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, et al. Tokyo guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci 2018;25:55-72.
• 3. Trust MD, Sheffield KM, Boyd CA, Benarroch-Gampel J, Zhang D, Townsend CM, Jr., et al. Gallstone pancreatitis in older patients: Are we operating enough? Surgery 2011;150:515-25.
• 4. Wilson CT, de Moya MA. Cholecystectomy for acute gallstone pancreatitis: early vs delayed approach. Scand J Surg 2010;99:81-5.
• 5. Khan M, Jehan F, Zeeshan M, Kulvatunyou N, Fain MJ, Saljuqi AT, et al. Failure to rescue after emergency general surgery in geriatric patients: does frailty matter? J Surg Res 2019;233:397-402.
• 6. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173:489-95.
• 7. Festi D, Dormi A, Capodicasa S, Staniscia T, Attili AF, Loria P, et al. Incidence of gallstone disease in Italy: results from a multicenter, population-based Italian study (the MICOL project). World J Gastroenterol 2008;14:5282-9.
• 8. Hendrickson M, Naparst TR. Abdominal surgical emergencies in the elderly. Emerg Med Clin North Am 2003;21:937-69.
• 9. Tokunaga Y, Nakayama N, Ishikawa Y, Nishitai R, Irie A, Kaganoi J, et al. Surgical risks of acute cholecystitis in elderly. Hepatogastroenterology 1997;44:671-6.
• 10. Bedirli A, Sakrak O, Sözüer EM, Kerek M, Güler I. Factors effecting the complications in the natural history of acute cholecystitis. Hepatogastroenterology 2001;48:1275-8.
• 11. Asiltürk Lülleci Z, Başyiğit S, Pirinççi Sapmaz F, Uzman M, Kefeli A, Yeniova A, et al. Comparison of ultrasonographic and laboratory findings of acute cholecystitis between elderly and nonelderly patients. Turk J Med Sci 2016;46:1428-33.
• 12. Barreiro Alonso E, Mancebo Mata A, Varela Trastoy P, Pipa Muñiz M, López Fernández E, Tojo González R, et al. Readmissions due to acute biliary edematous pancreatitis in patients without cholecystectomy. Rev Esp Enferm Dig 2016;108:473-8.
• 13. Lupinacci RM, Nadal LR, Rego RE, Dias AR, Marcari RS, Lupinacci RA, et al. Surgical management of gallbladder disease in the very elderly: are we operating them at the right time? Eur J Gastroenterol Hepatol 2013;25:380-4.
• 14. Launay-Savary MV, Rainfray M, Dubuisson V. Emergency gastrointestinal surgery in the elderly. J Visc Surg 2015;152(6 Suppl):S73-9.
• 15. Aucoin S, McIsaac DI. Emergency general surgery in older adults: a review. Anesthesiol Clin 2019;37:493-505.
• 16. McIsaac DI, Moloo H, Bryson GL, van Walraven C. The association of frailty with outcomes and resource use after emergency general surgery: a population-based cohort study. Anesth Analg 2017;124:1653-61.
• 17. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8-27.
• 18. Mesquita ARM, Iglesias AC. Risk factors for elective laparoscopic cholecystectomy morbimortality in elderly. Rev Col Bras Cir 2018;45:e1995.
• 19. Coelho JCU, Dalledone GO, Domingos MF, Nassif LT, de-Freitas ACT, Matias JEF. Results of laparoscopic cholecystectomy in the elderly. Rev Col Bras Cir 2018;45:e2020.
• 20. Yun SS, Hwang DW, Kim SW, Park SH, Park SJ, Lee DS, et al. Better treatment strategies for patients with acute cholecystitis and American Society of Anesthesiologists classification 3 or greater. Yonsei Med J 2010;51:540-5.
• 21. Ambe PC, Kaptanis S, Papadakis M, Weber SA, Jansen S, Zirngibl H. The treatment of Critically ill patients with acute cholecystitis. Dtsch Arztebl Int 2016;113:545-51.
• 22. Khan KT, Hemati K, Donovan AL. Geriatric physiology and the frailty syndrome. Anesthesiol Clin 2019;37:453-74.
• 23. Goeteyn J, Evans LA, De Cleyn S, Fauconnier S, Damen C, Hewitt J, et al. Frailty as a predictor of mortality in the elderly emergency general surgery patient. Acta Chir Belg 2017;117:370-5.
• 24. Orouji Jokar T, Ibraheem K, Rhee P, Kulavatunyou N, Haider A, Phelan HA, et al. Emergency general surgery specific frailty index: a validation study. J Trauma Acute Care Surg 2016;81:254-60.
• 25. Joseph B, Zangbar B, Pandit V, Fain M, Mohler MJ, Kulvatunyou N, et al. Emergency general surgery in the elderly: too old or too frail? J Am Coll Surg 2016;222:805-13.