Recurrence patterns and outcomes of symptomatic gallstone disease in the elderly

Table 2 Symptomatic gallstone disease index admission causes, severity, work-up, and management approaches by age group, n (%)/median (interquartile range)

Variables	< 80 years (n = 1929)	≥ 80 years (n = 1087)	P value
Gallstone disease index admission
Type of gallstone disease			< 0.001
Acute pancreatitis	689 (35.7)	252 (23.2)
Acute cholecystitis	463 (24.0)	368 (33.9)
Acute cholangitis	189 (9.8)	190 (17.5)
Symptomatic choledocholithiasis	208 (10.8)	94 (8.6)
Biliary colic	251 (13.0)	63 (5.8)
Any combination	129 (6.7)	120 (11.0)
Severity of acute pancreatitis1			0.751
Mild	535 (77.6)	194 (77.0)
Moderate	112 (16.3)	45 (17.9)
Severe	42 (6.1)	13 (5.2)
Severity of acute cholecystitis1			< 0.001
Mild	342 (73.9)	217 (59.0)
Moderate	105 (22.7)	116 (31.5)
Severe	16 (3.5)	35 (9.5)
Severity of acute cholangitis1			< 0.001
Mild	116 (61.4)	80 (42.1)
Moderate	59 (31.2)	87 (45.8)
Severe	14 (7.4)	23 (12.1)
Acute renal dysfunction			< 0.001
No	1847 (95.8)	974 (89.6)
Yes	80 (4.2)	113 (10.4)
Acute respiratory dysfunction			0.820
No	1893 (98.2)	1066 (98.1)
Yes	35 (1.8)	21 (1.9)
Acute cardiovascular dysfunction			0.027
No	1893 (98.1)	1053 (96.9)
Yes	36 (1.9)	34 (3.1)
Hospital stay (days)	6 (4, 10)	8 (5, 11)	< 0.001
Intensive care unit stay (days)	4 (3, 7)	3 (2, 6)	0.347
No	1889 (98.0)	1072 (98.7)
Yes	39 (2.0)	14 (1.3)
Follow-up time (months)	4.3 (1.9, 8.4)	8.7 (3.0, 18.4)	< 0.001
Initial diagnostic approach
Transabdominal ultrasonography (yes)	1776 (92.2)	1005 (92.5)	0.773
Computed axial tomography (yes)	702 (36.4)	394 (36.2)	0.920
Magnetic resonance imaging (yes)	539 (28.0)	207 (19.0)	< 0.001
Endoscopic ultrasound (yes)	291 (15.1)	109 (10.0)	< 0.001
Initial therapeutics
ERCP index admission (yes)	481 (24.9)	338 (31.1)	< 0.001
Sphincterotomy (yes)	457 (95.0)	322 (95.3)	0.867
Wirsung cannulation (yes)	104 (21.6)	52 (15.4)	0.025
Wirsung stent (yes)	67 (13.9)	40 (11.8)	0.381
Successful ERCP (yes)	392 (83.1)	279 (82.8)	0.783
Biliary stent (yes)	83 (17.3)	59 (17.5)	0.941
ERCP complications (yes)	79 (16.4)	49 (15.5)	0.455
Percutaneous transhepatic cholangiography (yes)	4 (0.2)	4 (0.4)	0.470
Cholecystostomy (yes)	99 (5.1)	144 (13.3)	< 0.001
Type of cholecystostomy			< 0.001
Endoscopic	5 (0.3)	24 (2.2)
Percutaneous	91 (4.7)	114 (10.5)
Both	3 (0.2)	6 (0.6)
Complications (yes)	5 (5.1)	6 (4.2)	0.761
Elective cholecystectomy (yes)	1329 (68.1)	243 (22.4)	< 0.001
Time to cholecystectomy (months)	4.3 (2.2, 6.8)	4.6 (2.4, 8.0)	0.034
< 3 months	478 (36.5)	73 (30.2)
3-6 months	407 (31.0)	70 (28.9)
> 6 months	426 (32.5)	99 (40.9)	0.032
Type of cholecystectomy			< 0.001
Laparoscopic	1200 (90.6)	197 (81.4)
Open after laparoscopic	64 (4.8)	19 (7.9)
Open	60 (4.5)	26 (10.7)
Complications (yes)	78 (5.9)	21 (8.6)	0.103

¹Severity was graded according to the Atlanta classification (2012) in the cases of acute pancreatitis and the Tokyo classification (2018) in the cases of acute cholecystitis and cholangitis.

ERCP: Endoscopic retrograde cholangiopancreatography.