Critical view of safety in elderly versus non-elderly patients with acute cholecystitis: prospective observational study

Abstract

BACKGROUND: One of the most frequent side effects of gallbladder stones is acute cholecystitis, which frequently requires emergency treatment. The aim of this study was to evaluate and examine the difficulties of the critical view of safety achievement in two age groups.METHODS: This study was conducted at Mansoura University Hospital, Faculty of Medicine, in the time frame from 2020 to 2023. The prospective study included data from all patients who met the selection criteria and were diagnosed with acute cholecystitis. During admission, each patient’s age, gender, preoperative comorbidities, surgical results, and postoperative complications were recorded. Statistical analysis used: The data was collected in a spreadsheet using Microsoft Excel, and the data was analyzed using the Statistical Package for Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY, USA).RESULTS: The elderly (>65 years, N.=107) and non-elderly (≤65 years, N.=78) groups were investigated. The intraoperative findings revealed that achieving the critical view of safety took a long time and required a longer operative time in the non-elderly group. Furthermore, 18 patients had wide cystic ducts that were managed using various methods such as HEM -O -LOK and Endo GIA staplers. The elderly, on the other hand, had a higher rate of hospitalization, conversion, and mortality. Postoperative complications such as wound complications, bile leakage, and chest infection were also observed in the elderly group.CONCLUSIONS: In the presence of acute cholecystitis, the critical view of safety can be obtained safely. In our study, the non-elderly group had a denser inflammatory process and a wider cystic duct. To avoid bile duct injury, various methods of controlling the cystic plate structures are used. Acute cholecystitis in the non-elderly presents a significant challenge in achieving a critical view of safety, but such difficulty can be accepted with optimization and careful diagnosis.