Biliary Tract Surgery in the Elderly

Cholecystectomy is the most common surgical procedure in the elderly. Published reports on this operation suffer from small sample sizes, crude analyses, erroneous conclusions, and unsupported recommendations. The authors reviewed all first operations for cholelithiasis at the North Carolina Memorial Hospital from 1973 to 1982 to assess factors associated with postoperative morbidity in patients aged 70 years or older after biliary tract surgery. These elderly patients (n = 142) had more frequent postoperative complications (26.1% vs. 12.0%, p less than 0.0001), and greater mortality (9.2% vs. 2.7%, p less than 0.005) than did 839 younger patients. Patients with preoperative cardiac, renal or neurologic problems had more frequent postoperative complications whether they were old or young. Postoperative complications were more frequent in the elderly for non-emergency surgery (21.2% vs. 9.7%) but not for emergency surgery (44.8% vs. 42.4%). Logistic regression analysis was used to determine independent predictors of postoperative complications. Age greater than or equal to 70 years was associated with an increase in risk that was not statistically significant.