Age-related differences pre-, intra-, and postcholecystectomy: A retrospective cohort study of 6,868 patients

Hadia Maqsood, Kalpesh Patel, Hamid Ferdosi, Anne M. Sill, Bin Wu, Thomas Buddensick, Amanda Sautter, Haroon Shaukat, Gisela Sulkowski, Dusty Marie Narducci, Mustafa Siddique, Farin Kamangar, Gopal C. Kowdley, Steven C. Cunningham

Research output: Contribution to journalArticle

Abstract

Background Cholecystectomy (CCY) is increasingly performed in older individuals. We sought to examine age-related differences in pre-, intra-, and postoperative factors at a community hospital, using a very large, single-institution cholecystectomy database. Materials and methods A retrospective review of 6868 patients who underwent CCY from 2001 to 2013 was performed. ROC analysis identified the optimal age cutoff when complications reached a significant inflection point (<55 and ≥55 years). Multiple clinical features and outcomes were measured and compared by age. Logistic regression was used to examine how well a set of covariates predicted postoperative complications. Results Older patients had significantly higher rates of comorbidities and underwent more extensive preoperative imaging. Intraoperatively, older patients had more blood loss, longer operative times, and more open operations. Postoperatively, older patients experienced more complications and had significantly different pathological findings. While holding age and gender constant, regression analyses showed that preoperative creatinine level, blood loss and history of previous operation were the strongest predictors of complications. The risk for developing complications increased by 2% per year of life. Conclusion Older patients have distinct pre-, intra-, and postoperative characteristics. Their care is more imaging- and cost-intensive. CCY in this population is associated with higher risks, likely due to a combination of comorbidities and age-related worsened physiological status. Pathologic findings are significantly different relative to younger patients. While removing the effect of age, preoperative creatinine levels, blood loss, and history of previous operation predict postoperative complications. Quantifying these differences may help to inform management decisions for older patients.

LanguageEnglish (US)
Pages119-126
Number of pages8
JournalInternational Journal of Surgery
Volume39
DOIs
StatePublished - Mar 1 2017

Fingerprint

Cohort Studies
Retrospective Studies
Cholecystectomy
Comorbidity
Creatinine
Community Hospital
Operative Time
ROC Curve
Logistic Models
Regression Analysis
Databases
Costs and Cost Analysis
Population

Keywords

  • Adenomyosis
  • Age
  • Cholecystectomy
  • Cholesterolosis
  • Complications
  • Elderly
  • Young

ASJC Scopus subject areas

  • Surgery

Cite this

Maqsood, H., Patel, K., Ferdosi, H., Sill, A. M., Wu, B., Buddensick, T., ... Cunningham, S. C. (2017). Age-related differences pre-, intra-, and postcholecystectomy: A retrospective cohort study of 6,868 patients. International Journal of Surgery, 39, 119-126. DOI: 10.1016/j.ijsu.2017.01.046

Age-related differences pre-, intra-, and postcholecystectomy : A retrospective cohort study of 6,868 patients. / Maqsood, Hadia; Patel, Kalpesh; Ferdosi, Hamid; Sill, Anne M.; Wu, Bin; Buddensick, Thomas; Sautter, Amanda; Shaukat, Haroon; Sulkowski, Gisela; Narducci, Dusty Marie; Siddique, Mustafa; Kamangar, Farin; Kowdley, Gopal C.; Cunningham, Steven C.

In: International Journal of Surgery, Vol. 39, 01.03.2017, p. 119-126.

Research output: Contribution to journalArticle

Maqsood, H, Patel, K, Ferdosi, H, Sill, AM, Wu, B, Buddensick, T, Sautter, A, Shaukat, H, Sulkowski, G, Narducci, DM, Siddique, M, Kamangar, F, Kowdley, GC & Cunningham, SC 2017, 'Age-related differences pre-, intra-, and postcholecystectomy: A retrospective cohort study of 6,868 patients' International Journal of Surgery, vol. 39, pp. 119-126. DOI: 10.1016/j.ijsu.2017.01.046
Maqsood H, Patel K, Ferdosi H, Sill AM, Wu B, Buddensick T et al. Age-related differences pre-, intra-, and postcholecystectomy: A retrospective cohort study of 6,868 patients. International Journal of Surgery. 2017 Mar 1;39:119-126. Available from, DOI: 10.1016/j.ijsu.2017.01.046
Maqsood, Hadia ; Patel, Kalpesh ; Ferdosi, Hamid ; Sill, Anne M. ; Wu, Bin ; Buddensick, Thomas ; Sautter, Amanda ; Shaukat, Haroon ; Sulkowski, Gisela ; Narducci, Dusty Marie ; Siddique, Mustafa ; Kamangar, Farin ; Kowdley, Gopal C. ; Cunningham, Steven C./ Age-related differences pre-, intra-, and postcholecystectomy : A retrospective cohort study of 6,868 patients. In: International Journal of Surgery. 2017 ; Vol. 39. pp. 119-126
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abstract = "Background Cholecystectomy (CCY) is increasingly performed in older individuals. We sought to examine age-related differences in pre-, intra-, and postoperative factors at a community hospital, using a very large, single-institution cholecystectomy database. Materials and methods A retrospective review of 6868 patients who underwent CCY from 2001 to 2013 was performed. ROC analysis identified the optimal age cutoff when complications reached a significant inflection point (<55 and ≥55 years). Multiple clinical features and outcomes were measured and compared by age. Logistic regression was used to examine how well a set of covariates predicted postoperative complications. Results Older patients had significantly higher rates of comorbidities and underwent more extensive preoperative imaging. Intraoperatively, older patients had more blood loss, longer operative times, and more open operations. Postoperatively, older patients experienced more complications and had significantly different pathological findings. While holding age and gender constant, regression analyses showed that preoperative creatinine level, blood loss and history of previous operation were the strongest predictors of complications. The risk for developing complications increased by 2{\%} per year of life. Conclusion Older patients have distinct pre-, intra-, and postoperative characteristics. Their care is more imaging- and cost-intensive. CCY in this population is associated with higher risks, likely due to a combination of comorbidities and age-related worsened physiological status. Pathologic findings are significantly different relative to younger patients. While removing the effect of age, preoperative creatinine levels, blood loss, and history of previous operation predict postoperative complications. Quantifying these differences may help to inform management decisions for older patients.",
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AU - Wu,Bin

AU - Buddensick,Thomas

AU - Sautter,Amanda

AU - Shaukat,Haroon

AU - Sulkowski,Gisela

AU - Narducci,Dusty Marie

AU - Siddique,Mustafa

AU - Kamangar,Farin

AU - Kowdley,Gopal C.

AU - Cunningham,Steven C.

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N2 - Background Cholecystectomy (CCY) is increasingly performed in older individuals. We sought to examine age-related differences in pre-, intra-, and postoperative factors at a community hospital, using a very large, single-institution cholecystectomy database. Materials and methods A retrospective review of 6868 patients who underwent CCY from 2001 to 2013 was performed. ROC analysis identified the optimal age cutoff when complications reached a significant inflection point (<55 and ≥55 years). Multiple clinical features and outcomes were measured and compared by age. Logistic regression was used to examine how well a set of covariates predicted postoperative complications. Results Older patients had significantly higher rates of comorbidities and underwent more extensive preoperative imaging. Intraoperatively, older patients had more blood loss, longer operative times, and more open operations. Postoperatively, older patients experienced more complications and had significantly different pathological findings. While holding age and gender constant, regression analyses showed that preoperative creatinine level, blood loss and history of previous operation were the strongest predictors of complications. The risk for developing complications increased by 2% per year of life. Conclusion Older patients have distinct pre-, intra-, and postoperative characteristics. Their care is more imaging- and cost-intensive. CCY in this population is associated with higher risks, likely due to a combination of comorbidities and age-related worsened physiological status. Pathologic findings are significantly different relative to younger patients. While removing the effect of age, preoperative creatinine levels, blood loss, and history of previous operation predict postoperative complications. Quantifying these differences may help to inform management decisions for older patients.

AB - Background Cholecystectomy (CCY) is increasingly performed in older individuals. We sought to examine age-related differences in pre-, intra-, and postoperative factors at a community hospital, using a very large, single-institution cholecystectomy database. Materials and methods A retrospective review of 6868 patients who underwent CCY from 2001 to 2013 was performed. ROC analysis identified the optimal age cutoff when complications reached a significant inflection point (<55 and ≥55 years). Multiple clinical features and outcomes were measured and compared by age. Logistic regression was used to examine how well a set of covariates predicted postoperative complications. Results Older patients had significantly higher rates of comorbidities and underwent more extensive preoperative imaging. Intraoperatively, older patients had more blood loss, longer operative times, and more open operations. Postoperatively, older patients experienced more complications and had significantly different pathological findings. While holding age and gender constant, regression analyses showed that preoperative creatinine level, blood loss and history of previous operation were the strongest predictors of complications. The risk for developing complications increased by 2% per year of life. Conclusion Older patients have distinct pre-, intra-, and postoperative characteristics. Their care is more imaging- and cost-intensive. CCY in this population is associated with higher risks, likely due to a combination of comorbidities and age-related worsened physiological status. Pathologic findings are significantly different relative to younger patients. While removing the effect of age, preoperative creatinine levels, blood loss, and history of previous operation predict postoperative complications. Quantifying these differences may help to inform management decisions for older patients.

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