My parent is in their eighties. Are they too old for gallbladder surgery?

The question is usually asked as though the choice were between an operation with risk and no operation without it. The studies that follow elderly patients over the years after an attack of acute cholecystitis do not describe that choice.

What happens when the gallbladder is left in#

An analysis of 29,818 Medicare beneficiaries admitted urgently or emergently with acute cholecystitis between 1996 and 2005, with a mean age of 77.7 years, found that a quarter of them did not have the gallbladder removed during that admission.

Of those who avoided surgery, 27 percent came to a cholecystectomy later anyway, and the operations performed at readmission were more often open. The authors concluded that cholecystectomy for acute cholecystitis in elderly patients should be performed during the initial hospitalisation.

What happens when it is taken out#

Surgery in this age group is not without cost, and the figures should be read as they are. A meta-analysis of eight studies covering 592 patients with a mean age of 81 having early cholecystectomy for acute cholecystitis reported conversion to open surgery in 23 percent, perioperative morbidity in 24 percent and mortality of 3.5 percent.

A population-based cohort of 47,500 patients aged 80 and over admitted with acute cholecystitis in England between 1997 and 2012 shows the shape of the trade-off directly. Thirty-day mortality was higher in those who had emergency surgery, 11.6 percent against 9.9 percent in those managed conservatively. Readmission rates and one-year mortality went the other way.

In the same English cohort, the way the operation was performed mattered considerably: a laparoscopic approach was associated with an 84 percent relative reduction in 30-day mortality compared with open surgery.

What the Korean series say about age itself#

A study at Kangbuk Samsung Hospital compared 353 patients aged 65 to 79 with 35 patients aged 80 and over, all having laparoscopic cholecystectomy. Mean operating time, conversion rate and the incidence of major postoperative complications were similar between the two age groups. What differed was the proportion classified as high risk, 20.0 percent against 5.7 percent.

Their conclusion was that perioperative outcomes were influenced by the severity of the gallbladder disease and not by chronological age, and that in patients in their eighties the operation should be done at an earlier, uncomplicated stage wherever possible.

A second Korean series, of 302 patients operated on for acute cholecystitis at Chosun University Hospital, found a different pattern on some measures: conversion rate, operating time and postoperative stay were all significantly higher in the group over 80, and drainage before surgery and endoscopic procedures were used more often. No bile leakage and no operative deaths were reported, and the authors concluded that laparoscopic cholecystectomy should be the standard approach in extremely elderly patients.

Taken together these say something narrower than that age does not matter. They say that age is not the variable that decides, that the condition of the gallbladder at the time of the operation is, and that the way to keep that condition favourable is not to wait.