The American surgeon
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The American surgeon · Aug 2011
Comparative StudyLaparoscopic cholecystectomy is safe but underused in the elderly.
Studies confirm that laparoscopic cholecystectomy (LC) is safe and efficacious for elderly patients. The purposes of this study were to evaluate if LC is underused in the elderly and if it is a safe option in that group. Open cholecystectomy (OC) and LC were compared in nonelderly (40 to 64 years) and elderly (65 years or older) matched patient groups identified with gallbladder disease using the American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2008). ⋯ Significant disparity exists between elderly and nonelderly patients in use of LC surgery. LC has a lower complication rate than OC; however, elderly undergo LC less often. Awareness needs to be raised for offering earlier operative intervention and the superior results of LC in the elderly.
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The American surgeon · Aug 2011
After-hours urgent and emergent surgery in the elderly: outcomes and prognostic factors.
Surgeons are becoming increasingly involved in the care of elderly patients. The purpose of this project was to evaluate contemporary outcomes of emergent surgeries performed after hours in elderly patients and to determine any risk factors for poor outcome. We retrospectively reviewed patients 80 years or older undergoing an urgent or emergent surgery at our medical center from 6 pm to 6 am from October 2006 through July 2009. ⋯ The only studied factors significantly associated with mortality were higher American Society of Anesthesiologists score (P = 0.004), increased intravenous fluids (P = 0.03), decreased intraoperative urine output (P = 0.03), and the need for intraoperative blood (P = 0.003). After-hours urgent and emergent surgery in the elderly has a high morbidity and mortality rate. We identified several risk factors for a poor prognosis that may be useful to the surgeon when discussing the patient's prognosis with the family.