SP9.7 - Emergency vs. elective biliary admissions in the elderly on a unit adopting index admission cholecystectomy and bile duct exploration. Patients over 70 years with biliary emergencies have more acute cholecystitis and empyema and need significantly more bile duct explorations

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Abstract Aim To compare operative and postoperative outcomes of benign biliary surgery in elderly patients. Methods A prospective database of cholecystectomies and bile duct explorations was analysed, comparing index admission surgery for biliary emergencies (Group I, 559, 63.2%) to elective surgery (Group II, 325, 36.8%) in the over 70. Results Group I Group II Females 312 (55.8) 210 (64.6) ASA grade 3 0r 4 236 (42.2) 102 (31.4) Presentations: Acute cholecystitis 132 (23.7) -- Pancreatitis 97 (17.4) -- Jaundice/Cholangitis 323 (57.8) -- Previous episodes Pain 40 (7.2) 7 (2.2) Cholecystitis 33 (5.9) 45 (13.8) Pancreatitis 9 (1.6) 24 (7.4) Jaundice 51 (9.1) 35 (10.8) Ultrasound findings GB Thick wall or contraction 162 (29) 53 (16.3) Bile duct dilatation 247 (44.2) 56 (17.2) Operative GB findings Acute 41 (7.3) 4 (1.2) Empyema 119 (21.3) 12 (3.7) Contracted 89 (15.9) 64 (19.7) Cholecystectomy Difficulty Grade I & II 188 (33.6) 183 (56.3) III 140 (25) 77 (23.7) IV 183 (32.7) 56 (17.2) V 46 (8.2) 9 (2.7) Abnormal IOC 314 (56.2) 122 (37.5) Bile Duct Exploration 308 (55.1) 97 (29.8) Operative time; median/range) 90 min/ 23-345 78.6min/ 21-270 Open conversion 7 (1.25) 2 (0.6) Morbidity 40 (6.7) 30 (10) Readmissions 49 (8.7) 12 (3.7) Reoperations 4 (0.6) 2 (0.6) Hospital stay; median/range 12 days/ 1-100 3 days/ 1-160 Mortality 6 (1.1) 0 Resolved in one episode 350 (62.8) 175 (53.8) * bold > statistically significant. Conclusions In spite of increased difficulty and higher incidence of bile duct exploration more emergencies than electives resolve in one episode. Other outcomes compare favourably with elective surgery. Index admission surgery is justified in the elderly.

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