Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently—Results and Insights from the ESTES Snapshot Audit
Authors: Bass Gary A. , Gillis Amy E. , Cao Yang , Mohseni Shahin ,   for the European Society for Trauma and Emergency Surgery (ESTES) Cohort Studies Group, Shamiyeh Andreas , Rosetti Lena , Klimbacher Günter , Klugsberger Bettina , Healy Paul , Moriarty Conor , Power Colm , Knightly Nauar , Hill Arnold DK , Winter Desmond C , Kelly Michael E , Creavin Ben E , Ryan Éanna J , Duffy Caoimhe C , Sugrue Michael , Moore Michael Hugh , Flanagan Louise , Ryan Jessica , Keady Conor , Fahey Brian , McKevitt Kevin L , Barry Kevin , Conlon Kevin C , Mentor Keno , Kazemi‐Nava Andrea , Julies Barbara , Ridgway Paul F , Kavanagh Dara O , Donnelly Mark , McCarrick Cathleen , Muhammad Umair , Connelly Tara M , Neary Paul C , Magalina Sabina , Cozza Valerio , LaGreca Antonio , Gui Daniele , Malagnino Alessia , Zago Mauro , Montuori Mauro , Biloslavo Alan , Samardzic Natasa , Fracon Stefano , Cosola Davide , de Manzini Nicolò , Fernandes Urânia , Avelar Paulo , Marques Rita , Esteves Ana Sofia , Marçal André , Gomes Carina , Machado Daniela , Teles Tobias , Neves Sofia , Semiao Miguel , Cunha Rui , Pereira Jorge , Constantino Júlio , Sá Milene , Casimiro Carlos , Ionescu Lidia , Livadariu Roxana , Stirbu Ludmila , Danila Radu , Timofte Daniel , Astefaniei Bogdan , Olavarria Aitor Landaluce , Mateos Begoña Estraviz , Taranco Jaime Gonzalez , Gomez David , Barrutia Jon , Zeballos Julio , Garcia Dieter Morales , Najera Ana Lozano , Tolaretxipi Erik Gonzalez , Tallon‐Aguilar Luis , Pintor‐Tortolero José , Sanchez‐Arteaga Alejandro , Cruzado Virginia Duran‐Muñóz , Camacho‐Marente Violeta , Tinoco‐Gonzalez José , Älverdal Anna , Redeen Stefan , Mohseni Shahin , Ismail Ahmad Mohammad , Ahl Rebecka , Marinos Spyros , Warner Naomi , Patel Rikhil , Magro Tania , Sunthareswaran Romeshan , Mihailescu Andrei , Pokusewski Goran , Bubuianu Al exandru Leopold , Dimitriu Corneliu , Paraoan Marius , Desai Arjun , Jones Katie , Mlotshwa Makhosini , Ross Kenny , Lambracos Simon , Tryliskyy Yegor , Cullinane Daniel C 
Published: April 2021

Background

Accrued comorbidities are perceived to increase operative risk. Surgeons may offer operative treatments less often to their older patients with acute complicated calculous biliary disease (ACCBD). We set out to capture ACCBD incidence in older patients across Europe and the currently used treatment algorithms.

Methods

The European Society of Trauma and Emergency Surgery (ESTES) undertook a snapshot audit of patients undergoing emergency hospital admission for ACCBD between October 1 and 31 2018, comparing patients under and ≥ 65 years. Mortality, postoperative complications, time to operative intervention, post‐acute disposition, and length of hospital stay (LOS) were compared between groups. Within the ≥ 65 cohort, comorbidity burden, mortality, LOS, and disposition outcomes were further compared between patients undergoing operative and non‐operative management.

Results

The median age of the 338 admitted patients was 67 years; 185 patients (54.7%) of these were the age of 65 or over. Significantly fewer patients ≥ 65 underwent surgical treatment (37.8% vs. 64.7%, p < 0.001). Surgical complications were more frequent in the ≥ 65 cohort than younger patients, and the mean postoperative LOS was significantly longer. Postoperative mortality was seen in 2.2% of patients ≥ 65 (vs. 0.7%, p = 0.253). However, operated elderly patients did not differ from non‐operated in terms of comorbidity burden, mortality, LOS, or post‐discharge rehabilitation need.

Conclusions

Few elderly patients receive surgical treatment for ACCBD. Expectedly, postoperative morbidity, LOS, and the requirement for post‐discharge rehabilitation are higher in the elderly than younger patients but do not differ from elderly patients managed non‐operatively. With multidisciplinary perioperative optimization, elderly patients may be safely offered optimal treatment.

Trial Registration

ClinicalTrials.gov (Trial # NCT03610308).