Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta-analysis

Background Laparoscopic cholecystectomy is increasingly performed in an ever ageing population; however, the risks are poorly quantified. The study aims to review the current evidence to quantify further the postoperative risk of cholecystectomy in the elderly population compared to younger patients. Method A systematic literature search of PubMed, EMBASE and the Cochrane Library databases were conducted including studies reporting laparoscopic cholecystectomy in the elderly population. A meta-analysis was reported in accordance with the recommendations of the Cochrane Library and PRISMA guidelines. Primary outcome was overall complications and secondary outcomes were conversion to open surgery, bile leaks, postoperative mortality and length of stay. Results This review identified 99 studies incorporating 326,517 patients. Increasing age was significantly associated with increased rates of overall complications (OR 2.37, CI(95%)2.00-2.78), major complication (OR 1.79, CI(95%)1.45-2.20), risk of conversion to open cholecystectomy (OR 2.17, CI(95%)1.84-2.55), risk of bile leaks (OR 1.50, CI(95%)1.07-2.10), risk of postoperative mortality (OR 7.20, CI(95%)4.41-11.73) and was significantly associated with increased length of stay (MD 2.21 days, CI(95%)1.24-3.18). Conclusion Postoperative outcomes such as overall and major complications appear to be significantly higher in all age cut-offs in this meta-analysis. This study demonstrated there is a sevenfold increase in perioperative mortality which increases by tenfold in patients > 80 years old. This study appears to confirm preconceived suspicions of higher risks in elderly patients undergoing cholecystectomy and may aid treatment planning and informed consent.