Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently—Results and Insights from the ESTES Snapshot Audit (original) (raw)
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Acute Biliary Pancreatitis is Associated With Adverse Outcomes in the Elderly
Journal of Clinical Gastroenterology, 2018
Goals and Background: In the elderly (age, 65 y or older), acute pancreatitis is most frequently because of gallstones; however, there is a paucity of national estimates evaluating outcomes of acute biliary pancreatitis (ABP). Hence, we utilized a representative population database to evaluate the outcomes of ABP among the elderly. Study: The National Readmission Database provides longitudinal follow-up of inpatients for 1 calendar-year. All adult inpatients (18 y or older) with an index primary admission for ABP between 2011 and 2014 were evaluated for clinical outcomes of mortality, severe acute pancreatitis (SAP), and 30-day readmission. Outcomes between age groups (≥ 65 vs. <65 y) were compared using multivariate and one-to-one propensity score-matched analyses. Results: Among 184,763 ABP admissions, 41% were elderly. Index mortality and SAP rates in the elderly were 1.96% and 21.5%, respectively. Elderly patients underwent more ERCPs (27.5% vs. 23.6%; P < 0.001) and less frequent cholecystectomies (44.4% vs. 58.7%; P < 0.001). Elderly patients had increased odds of mortality and SAP along with an age-dependent increase in the odds of adverse outcomes; patients aged 85 years or older demonstrated the highest odds of SAP [odds ratio (OR), 1.3; 95% confidence interval (CI): 1.2, 1.4] and mortality (OR, 2.2; 95% CI: 1.7, 2.9) within in the elderly cohort. Propensity score-matched analysis substantiated that mortality (OR, 2.8; 95% CI: 2.2, 3.5) and SAP (OR, 1.2; 95% CI: 1.1, 1.3) were increased in the elderly. Conclusions: Current national survey reveals adverse clinical outcomes among elderly patients hospitalized with ABP. Consequently, there is a need for effective management strategies for this demographic as the aging population is increasing nationally.
The Internet Journal of Surgery, 2007
14 preoperative risk factors were evaluated in 78 patients retrospectively which have an effect on postoperative mortality and morbidity undergoing surgery of biliary tract. Risk factors considered were 5 clinical (age, disease, fever, history of jaundice, history of diabetes) and 9 biochemical (hematocrit, total leucocyte count, raised prothrombin time, serum creatinine, serum albumin, serum bilirubin, AST, ALT, ALP). The type of surgery performed was also taken into consideration. Type 1 involved CBD exploration and T tube drainage; Type 2 involved biliary enteric anastomosis; Type 3 involved major surgeries like Whipple's procedure. Patients undergoing Type 3 surgery involving resection of pancreas were at the highest risk of mortality (p value of <0.001). Preoperative risk factors-history of jaundice >21 days (p value <0.02), hematocrit of <30% (p value <0.0005), raised prothrombin time of >1.5 times control (p value <0.05) and a serum albumin of <3.0 g/dl (p value <0.05) contributed significantly to postoperative mortality. There was a proportionately higher mortality in patients >60 years of age and having malignant disease but it was not statistically significant. The complications seen most frequently after biliary surgery in order of frequency were wound infection (21%), pulmonary complications (18%), sepsis (11%), renal failure (7%), urinary tract infection (7%), GI hemorrhage (3%) and abdominal abscess (3%). Postoperative renal failure and sepsis were highly predictive of mortality. Mortality increased as the number of risk factors increased. Surgery after treatment of correctable risk factors decreased postoperative mortality and morbidity.
Open Biliary Tract Surgery: Multivariate Analysis of Factors Affecting Mortality
Digestive Surgery, 1999
Background/Aim: The overall mortality rate in patients undergoing supraduodenal choledochotomy for benign biliary tract disease is around 3%. The aim of this study is to identify and quantify factors affecting the mortality in a group of patients undergoing open common bile duct exploration for benign biliary disease. Methods: Patients (n = 158) who underwent common bile duct exploration during a 5-year period in a teaching hospital were retrospectively reviewed. Results: Univariate and multivariate statistical analyses were performed. The former identified four statistically significant variables: age (p ! 0.001), acute cholangitis on admission (p ! 0.001), heart disease (p ! 0.05), and a dilated common bile duct on preoperative ultrasound scan (p ! 0.05). Multivariate analysis identified three variables which independently increased operative mortality: age (p = 0.05), heart disease (p = 0.03), and cholangitis (p = 0.008). The latter was associated with the greatest operative mortality, since it increased almost eight times the risk to die after surgical intervention. Conclusion: We conclude that an adequate perioperative cardiovascular management may be important in order to improve surgical outcome. Appro-priate antibiotic prophylaxis and subsequent treatment after routine operative bile cultures may reduce septic complications and mortality. Finally, an alternative procedure, such as endoscopic sphincterotomy, may be indicated in high-risk patients in order to drain the common bile duct preoperatively and to decrease the risk of unresponsive biliary sepsis.
Current Status of Surgical Treatment of Biliary Diseases in Elderly Patients in China
Chinese Medical Journal, 2018
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Gastrointestinal endoscopy, 2017
Bile duct surgery (BDS), percutaneous transhepatic cholangiography (PTC), and endoscopic retrograde cholangiopancreatography (ERCP) are alternative interventions used to treat biliary disease. We aim to describe trends in ERCP, BDS, and PTC on a nationwide level in the United States. We used the National Inpatient Sample to estimate age-standardized utilization trends of inpatient diagnostic ERCP, therapeutic ERCP, BDS, and PTC between 1998 and 2013. We calculated average case fatality, length of stay, patient demographic profile (age, gender, payer), and hospital characteristics (hospital size and metropolitan status) for these procedures. Total biliary interventions decreased over the study period from 119.8 to 100.1 per 100,000. Diagnostic ERCP utilization decreased by 76%, and therapeutic ERCP utilization increased by 35%. BDS rates decreased by 78%, and PTC rates decreased by 24%. ERCP has almost completely supplanted surgery for the management of choledocholithiasis. Fatality ...
Outcome of elderly patients after acute biliary pancreatitis
Bioscience trends, 2018
The specific management and outcome of acute biliary pancreatitis in elderly patients is not well established. The aim of this study was to assess the outcome of elderly compared to younger patients after acute biliary pancreatitis. Retrospective analysis of consecutive patients admitted with acute biliary pancreatitis between January 2006 and December 2012. Elderly patients (≥ 70 years) were compared to younger patients (< 70 years) in a case-control study. Comorbidities were assessed according to the Charlson score. Clinical (Atlanta score) and radiological (Balthazar and computed tomography severity index scores) severity were analyzed, as well as clinical outcome. Among 212 patients admitted with acute biliary pancreatitis, 76 were > 70 years (35.8%). Elderly patients had a higher Charlson comorbidity index score at admission (p < 0.001). No difference was observed in terms of clinical and radiological severity of acute pancreatitis. The median hospital stay was longer ...
The Turkish Journal of Gastroenterology, 2019
Background/Aims: The present study aimed at investigating the long-term outcomes and prognostic factors of patients with biliary atresia (BA) diagnosed and followed at a single center. Materials and Methods: Patients with BA treated during 1994-2014 at a large-volume pediatric tertiary referral center were reviewed retrospectively with regard to demographic, clinical, laboratory, and diagnostic characteristics for identifying the prognostic factors and long-term clinical outcomes. Results: Overall, 81 patients (49 males, 32 females) were included. Mean age at diagnosis was 73.1±4.7 (median: 64) days. Of the patients included, 78 patients (96%) underwent a portoenterostomy procedure. Mean age at operation was 76.8±4.7 (median: 72) days. The surgical success rate was 64.8%. A younger age (either at diagnosis or surgery) was the only determinant of surgical success. The 2-, 5-, and 10-year overall survival (OS) rates, including all patients with or without liver transplantation, were 75%, 73%, and 71% respectively, whereas the 2-, 5-, and 10-year survival rates with native liver (SNL) were 69%, 61%, and 57%, respectively. Mean follow-up duration was 9.4±7.5 years. Successful surgery, presence of fibrosis and/or cirrhosis on the liver pathology, and prothrombin time [international normalized ratio (INR)] at presentation were independent prognostic factors for both OS and SNL. Conclusion: A younger age at diagnosis is strongly associated with surgical success in BA. Surgical success, the prothrombin time (INR) at presentation, and liver pathology are independent prognostic factors affecting the long-term outcomes in patients with BA. Therefore, timely diagnosis and early referral to experienced surgical centers are crucial for optimal management and favorable long-term results in BA.