Perioperative Outcomes after Elective Laparoscopic Cholecystectomy in High Risk Patients
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Abstract
Background: The global population is aging, leading to an increased incidence of acute cholecystitis and associated complications in the elderly. While laparoscopic cholecystectomy is the gold standard for treating acute cholecystitis, its safety and outcomes in high-risk, elderly patients with comorbidities are not well-documented.
Objective: To compare postoperative complications, hospital stay duration, and nursing care requirements between high-risk elderly patients undergoing tube cholecystostomy versus early elective laparoscopic cholecystectomy for acute cholecystitis.
Methods: This cross-sectional comparative study was conducted at Combined Military Hospital Rawalpindi from July 2021 to January 2022. A total of 70 patients aged 40-80 years and classified as ASA 3 or 4 were included. Patients were divided into two groups: Group 1 (n=35) underwent tube cholecystostomy followed by interval cholecystectomy after six weeks; Group 2 (n=35) underwent early elective laparoscopic cholecystectomy within 72 hours of admission. Data on hospital stay, postoperative complications, and nursing care were collected and analyzed using SPSS version 25.0. Quantitative data were presented as mean ± standard deviation (SD), and qualitative data as frequency and percentage. Independent t-tests were applied, with a p-value of less than 0.05 considered statistically significant.
Results: In Group 1, 91% of patients had a hospital stay of less than 5 days compared to 11% in Group 2 (p=0.000). Group 1 had 94% of patients nursed in the ward/HDU, while 94% of Group 2 required ICU care (p=0.000). Postoperative complications were significantly lower in Group 1, with 97% having no complications compared to 34% in Group 2 (p=0.000). Only 3% of Group 1 required multidisciplinary team management versus 66% in Group 2.
Conclusion: Tube cholecystostomy is a safer and more effective initial management strategy for high-risk elderly patients with acute cholecystitis, leading to shorter hospital stays, less intensive postoperative care, and fewer complications compared to early elective laparoscopic cholecystectomy.
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References
Litwin DE, Cahan MA. Laparoscopic Cholecystectomy. Surg Clin North Am. 2008;88(6):1295-313.
Olsen DO. Laparoscopic Cholecystectomy. Am J Surg. 1991;161(3):339-44.
Macintyre IMC, Wilson RG. Laparoscopic Cholecystectomy. J Br Surg. 1993;80(5):552-9.
Soper NJ. Laparoscopic Cholecystectomy. Curr Probl Surg. 1991;28(9):587-655.
Grace PA, Quereshi A, Coleman J, Keane R, McEntee G, Broe P, et al. Reduced Postoperative Hospitalization After Laparoscopic Cholecystectomy. Br J Surg. 1991;78(2):160-2.
Kehlet H, Gray AW, Bonnet F, Camu F, Fischer HBJ, McCloy RF, et al. A Procedure-Specific Systematic Review and Consensus Recommendations for Postoperative Analgesia Following Laparoscopic Cholecystectomy. Surg Endosc. 2005;19:1396-415.
Gustafsson S, Strömqvist M, Ekelund J, Engström Å. Factors Influencing Early Postoperative Recovery After Laparoscopic Cholecystectomy. J PeriAnesth Nurs. 2020;35(1):80-4.
Sadati L, Pazouki A, Mehdizadeh A, Shoar S, Tamannaie Z, Chaichian S. Effect of Preoperative Nursing Visit on Preoperative Anxiety and Postoperative Complications in Candidates for Laparoscopic Cholecystectomy: A Randomized Clinical Trial. Scand J Caring Sci. 2013;27(4):994-8.
Mitchell M. Nursing Intervention for Day-Case Laparoscopic Cholecystectomy. Nurs Stand. 2007;22(6).
Kadhim H. Assessment of Postoperative Nurses' Interventions for the Patients with Laparoscopic Cholecystectomy at Baghdad Teaching Hospitals. Iraqi Natl J Nurs Spec. 2014;27(1):11-22.
Brenner P, Kautz DD. Postoperative Care of Patients Undergoing Same-Day Laparoscopic Cholecystectomy. AORN J. 2015;102(1):15-32.
Jensen K, Kehlet H, Lund CM. Post-Operative Recovery Profile After Laparoscopic Cholecystectomy: A Prospective, Observational Study of a Multimodal Anaesthetic Regime. Acta Anaesthesiol Scand. 2007;51(4):464-71.
Shamiyeh A, Wayand W. Laparoscopic Cholecystectomy: Early and Late Complications and Their Treatment. Langenbecks Arch Surg. 2004;389:164-71.
Berber E, Engle KL, String A, Garland AM, Chang G, Macho J, et al. Selective Use of Tube Cholecystostomy With Interval Laparoscopic Cholecystectomy in Acute Cholecystitis. Arch Surg. 2000;135(3):341-6.
Khasawneh MA, Shamp A, Heller S, Zielinski MD, Jenkins DH, Osborn JB, et al. Successful Laparoscopic Cholecystectomy After Percutaneous Cholecystostomy Tube Placement. J Trauma Acute Care Surg. 2015;78(1):100-4.
Suzuki K, Bower M, Cassaro S, Patel RI, Karpeh MS, Leitman IM. Tube Cholecystostomy Before Cholecystectomy for the Treatment of Acute Cholecystitis. JSLS. 2015;19(1).
Woodward SG, Rios-Diaz AJ, Zheng R, McPartland C, Tholey R, Tatarian T, et al. Finding the Most Favorable Timing for Cholecystectomy After Percutaneous Cholecystostomy Tube Placement: An Analysis of Institutional and National Data. J Am Coll Surg. 2021;232(1):55-64.
Lin D, Wu S, Fan Y, Ke C. Comparison of Laparoscopic Cholecystectomy and Delayed Laparoscopic Cholecystectomy in Aged Acute Calculous Cholecystitis: A Cohort Study. Surg Endosc. 2020;34:2994-3001.
Nikfarjam M, Shen L, Fink MA, Muralidharan V, Starkey G, Jones RM, et al. Percutaneous Cholecystostomy for Treatment of Acute Cholecystitis in the Era of Early Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2013;23(5):474-80.
Hung YL, Chen HW, Fu CY, Tsai CY, Chong SW, Wang SY, et al. Surgical Outcomes of Patients With Maintained or Removed Percutaneous Cholecystostomy Before Intended Laparoscopic Cholecystectomy. J Hepatobiliary Pancreat Sci. 2020;27(8):461-9.
Schlottmann F, Gaber C, Strassle PD, Patti MG, Charles AG. Cholecystectomy vs. Cholecystostomy for the Management of Acute Cholecystitis in Elderly Patients. J Gastrointest Surg. 2019;23:503-9.