Acute Cholecystitis in the Elderly Gunnar Edlund, MD, PhD, M i k a e l Ljungdahl, MD, Ostersund, Sweden

After a controlled randomized trial, the management of patients with acute cholecystitis was changed from delayed to early cholecystectomy. The results obtained in 125 consecutive patients some years before the trial and in 144 consecutive patients after the trial were compared. All patients were 70 years or older. The comparison confirmed that early cholecystectomy reduces morbidity and mortality. Early cholecystectomy for acute cholecystitis in the elderly is strongly recommended.

uring the late 1960s, a randomized trial on the treatment of acute cholecystitis was performed at our D hospital [1]. The results favored early cholecystectomy. After the trial, conservative treatment was replaced by early operation as the treatment of choice. The aim of the current study was to evaluate the effect of a complete change from conservative treatment to early cholecystectomy in elderly patients 70 years or older. PATIENTS AND METHODS All patients 70 years or older treated for acute cholecystitis between January 1, 1960, and December 31, 1965 (pre-trial period), and between January 1, 1974, and December 31, 1979 (post-trial period), were surveyed. Before the trial, the general guideline was conservative treatment of the acute attack followed by discharge and readmission 6 to 8 weeks later for definitive surgery. Conservative treatment consisted of bed rest, infusions, and antibiotics. Surgery during the attack was only resorted to when judged mandatory in patients whose condition had deteriorated. After the trial, the recommended treatment was bed rest, correction of electrolyte imbalance, and antibiotics, and the patient was scheduled for an operation on the next routine list after a diagnosis had been obtained, irrespective of the duration of symptoms. When no reliable diagnosis was made during the attack, or when for some other reason an operation was not feasible, the patient was discharged, oral cholecystoFrom the Department of Surgery, Ostersunds sjukhus, t)stersund, Sweden. Requests for reprints.should be addressed to Gunnar Edlund, MD, Department of Surgery, Ostersunds sjukhus, $831 83 Ostersund, Sweden. Manuscript submitted February 14, 1989, revised June 23, 1989, and accepted June 29, 1989.

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graphy was performed, and the patient was readmitted for surgery. For details of operative routines and technique, the reader is referred to the earlier study [2]. Significance was tested with the chi-square test, Fisher's exact test, or the Mann-Whitney U test when applicable as described by Siegel [3]. RESULTS Table I gives the sex and age distributions of the two series treated for acute cholecystitis. There were no significant differences. Clinical and treatment details are given in Table II. There was little difference between the two series as to the number of patients with high fever; nor was there any difference in the percentage of operations performed by specialists or in that in which cholangiography was performed. Figure 1 shows the management and mortality. Before the trial, eight patients underwent emergency surgery. Three of these patients died. The remaining 117 patients were treated conservatively and there were 11 deaths. Fifty-six of the remaining 106 patients did not undergo definitive treatment (patients refused operation or were deemed unfit for surgery). Delayed operation was performed in 50 patients, and there were 11 deaths. In six of these fatal cases, a fistula or an abscess was present. The net result was 25 deaths in 125 patients. After the trial, 105 of 144 patients underwent early surgery, with 6 postoperative deaths. Only 39 patients were treated conservatively, and there were 3 deaths. Fifteen of the patients either refused readmission or had an intervening illness; 21 underwent delayed surgery. In this subgroup, there was no mortality, i.e., significantly less than after delayed surgery in the earlier period (p

Acute cholecystitis in the elderly.

After a controlled randomized trial, the management of patients with acute cholecystitis was changed from delayed to early cholecystectomy. The result...
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