3% among selleck products those undergoing an open procedure. This study also observed lower rates in morbidity among elderly patients undergoing laparoscopic compared with open cholecystectomy. Compared to younger patients, the rates were higher in the elderly population overall. However, rates significantly declined when comparing open versus laparoscopic cholecystectomy in the aged-matched elderly groups. Clinically, this translated to reduced LOS and decreased disability, reflected by the fact that more patients were primarily discharged home directly from hospital. Legner et al. [9] reported that elderly patients discharged to an institutional care facility following abdominopelvic surgery had a 4-fold increase in 1-year mortality [9].
Based on this finding, it would appear that elderly patients undergoing laparoscopic compared with open cholecystectomy may also have improved 1-year outcomes given that higher numbers of these patients were discharged directly to their homes. To our knowledge, this is the largest, comprehensive study of its kind examining the trends in adoption of laparoscopic cholecystectomy among elderly patients and outcomes of laparoscopic cholecystectomy in this population. Other studies examining outcomes of laparoscopic cholecystectomy in the elderly population have been limited to single institutions [10�C16]. The findings from such studies are comparable to our study describing decreased morbidity and mortality, LOS, and surgical complications among elderly patients undergoing laparoscopic cholecystectomy.
Our study validates these single institutional findings using a large generalizable sample from across the US. While current literature supports the role of laparoscopic cholecystectomy in elderly patients, it should also be acknowledged that elderly patients more commonly present with complex biliary disease resulting in increased complication rates and mortality regardless of procedure choice (open or laparoscopic). Limitations. This was a retrospective study of a large database and hence limitations inherent to any administrative database such as HCUP-NIS are noted. A limitation of this study was the fact that there is no ICD-9 code for conversion from laparoscopic to open cholecystectomy; hence, we were unable to calculate the rate of conversion. However, HCUP-NIS is a well-validated and rigorously maintained database with a low error rate.
Operative details such as Batimastat operative duration, findings of gangrenous or perforated cholecystitis, postdischarge followup including readmissions, and postdischarge mortality are not available in HCUP-NIS. A limitation of the NIS database, however, is that ASA class is not available. We were able to assess the comorbidities of the elderly and the nonelderly patients, but the focus of this study is on the discrepancy in the rates of performance of laparoscopy in the elderly compared with the nonelderly.