A. Kothari1,2, M. Zapf1, J. Driver1, T. Markossian2, P. Kuo1 1Loyola University Chicago Stritch School Of Medicine,Surgery,Maywood, IL, USA 2Loyola University Chicago Stritch School Of Medicine,Public Health Sciences,Maywood, IL, USA
Introduction: The management of acute cholecystitis in octogenarians represents a unique challenge. We sought to determine if patient-level characteristics could be used to develop a tool to predict 30-day readmissions, non-operative management (cholecystostomy), and surgical complications.
Methods: We queried the Healthcare Cost and Utilization Project (HCUP) Florida State Inpatient Database (2009-2011) to define our population of interest. Included were all patients ≥80 years old presenting with acute cholecystitis. Excluded were patients with complicated cholecystitis, acalculus cholecystitis, and common bile duct obstruction. Patient factors included: age, co-morbidities, conditions present on admission, nutrition status, and point of origin. Outcomes of interest included: 30 day re-admission, length of stay, post-operative complications, cost, and timing of surgery.
Results:A total of 36,769 patients presented with acute cholecystitis from 2009-2011. Patients ≥ 80 years old (3,579/36,769) defined our study population. When compared to patients ≤65 years old (n=24,693), octogenarians had a higher rate of 30-day readmission (14.5% vs 6.4%, p<0.0001), were less likely to undergo surgical intervention (70.7% vs 91.8%, p<0.0001), and had more major surgical complications (5.8% vs 2.6%, p<0.0001). In the octogenarian sub-population, chronic anemia (OR 1.31, [1.06,1.61]*) and coronary artery disease (OR 1.24, [1.02,1.51]*) were independent predictors for readmission within 30 days. Independent factors predicting against cholecystectomy included CHF (OR 0.65, [0.54,0.78]*), PVD (OR 0.66, [0.0.52,0.84]*), acute kidney injury (OR 0.50, [0.39,0.64]*), and sepsis on presentation (OR 0.58, [0.45,0.73]*). Factors predicting major surgical complications included congestive heart failure (OR 1.76, [1.14,2.69]*), electrolyte abnormalities (OR 2.49, [1.65,3.77]*), renal failure (OR 1.75, [1.13, 2.72)*], and weight loss <10 lbs (OR 6.91, [3.62, 13.15]*). *=95% C.I.
Conclusion:Understanding the factors influencing the inpatient course of octogenarians presenting with acute cholecystitis offers areas for intervention with the goal of improving outcomes. Developing a prediction tool based on this data may reduce readmissions and guide clinical decision-making.