{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T18:59:26Z","timestamp":1783709966808,"version":"3.55.0"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,7,24]],"date-time":"2017-07-24T00:00:00Z","timestamp":1500854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,7,24]],"date-time":"2017-07-24T00:00:00Z","timestamp":1500854400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Globally, the number of people aged 80 years or over, the \u201coldest old,\u201d is the fastest growing population group. Because of the strong association between age and gallstone disease, both prevalence and incidence of this disease are increasing. The feasibility of the cholecystectomy in octogenarians has been evaluated in several studies that confirmed the safety of the operation. However, the safety of this procedure in nonagenarians is still controversial. The aim of this study was to evaluate the safety of cholecystectomies in nonagenarians and identify related predictors for postoperative hospital length of stay (LOS) and in\u2010hospital mortality up to 30\u00a0days postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>More than 500 cholecystectomies, both open and laparoscopic, were performed between January 2000 and September 2015 at our institution in patients 80 years and older. These statistics include both elective and emergent admissions. A retrospective review of charts over the last 15 years was conducted to compare mortality and length of postoperative stay among two patient groups: 319 octogenarians and 36\u00a0nonagenarians. Parameters evaluated include demographics, surgical presentation, American Society of Anesthesiologists (ASA) score, main diagnosis, comorbidities, type of surgery performed, LOS and in\u2010hospital mortality. All data were analyzed with STATA (v.13) software, using a multivariate logistic regression after determining the statistically significant variables through a stepwise regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found out that being nonagenarian, compared to octogenarian, is not a significant risk factor in terms of LOS and in\u2010hospital mortality within 30\u00a0days postoperatively. Despite that, the mortality rate among nonagenarians is still remarkably high as almost every patient was admitted in an emergent setting. The most remarkable predictor for mortality among the two groups was an \u201cafternoon\/night emergency\u201d surgical presentation (OR 25.5, CI 1.53\u201342.35, <jats:italic>p<\/jats:italic> = 0.02). Thus, the surgical emergency management for gallbladder disease at our institution should be critically reevaluated. Performing the procedure in laparoscopy predicted a significant reduction (\u22125\u00a0days, CI \u22128.5 to \u22121.4, <jats:italic>p<\/jats:italic> = 0.006) of LOS, while presenting with \u201cgallbladder and bile duct stones\u201d (+6.3\u00a0days, CI 1.5\u201311.1, <jats:italic>p<\/jats:italic> = 0.01) or \u201cacalculous cholecystitis\u201d (+4.7\u00a0days, CI 0.4\u20139.2, <jats:italic>p<\/jats:italic> = 0.03) had the opposite effect. Despite the remarkable mortality rate of our series, being nonagenarian should not be considered as a reason to avoid gallbladder surgery in case of need. Our study suggests that nonagenarians are more suitable surgical candidates than may have previously expected.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-017-4147-8","type":"journal-article","created":{"date-parts":[[2017,7,24]],"date-time":"2017-07-24T17:22:31Z","timestamp":1500916951000},"page":"73-81","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["How Safe is Performing Cholecystectomy in the Oldest Old? A 15\u2010year Retrospective Study from a Single Institution"],"prefix":"10.1002","volume":"42","author":[{"given":"Matteo","family":"Novello","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), S. Orsola\u2010Malpighi Hospital University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Gori","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salomone","family":"Di Saverio","sequence":"additional","affiliation":[{"name":"Department of Surgery Carlo Alberto Pizzardi Maggiore Hospital Largo Nigrisoli 2 Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Bianchin","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), S. Orsola\u2010Malpighi Hospital University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Maestri","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), S. Orsola\u2010Malpighi Hospital University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Vito","family":"Mandarino","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), S. Orsola\u2010Malpighi Hospital University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Cavallari","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), S. Orsola\u2010Malpighi Hospital University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Nardo","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), S. Orsola\u2010Malpighi Hospital University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,7,24]]},"reference":[{"key":"e_1_2_6_2_2","unstructured":"UN. World Population Ageing 2015(2015). doi:ST\/ESA\/SER.A\/390"},{"key":"e_1_2_6_3_2","first-page":"114","volume-title":"Department of Economic and Social Affairs, P. D. World Population Ageing","author":"United Nations","year":"2013"},{"key":"e_1_2_6_4_2","unstructured":"DasRA(2015)Silver Tsunami invades the health of nations\u2014forbes. 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