The Association Between Frailty and the Acute Management of Symptomatic Gallstone Disease in Older Adults

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BACKGROUND: Early laparoscopic cholecystectomy is recommended for symptomatic gallstone disease. The role of frailty on adverse outcomes post-operatively is well described in the surgical literature. We hypothesised that frailty is associated with acute management decisions in symptomatic gallstone disease in older people. AIMS: This study aims to describe the characteristics, management and outcomes of older people ≥ 65 years admitted with symptomatic gallstone disease, and to examine the association between frailty and the acute management approach in this patient population. METHODS: This retrospective cohort study included consecutive patients aged ≥ 65 years admitted to the Acute Surgical Unit with symptomatic gallstone disease between 1 February 2019 and 31 January 2021. Frailty was quantified by the Clinical Frailty Scale. The primary outcome was the acute management approach, defined as intervention (surgery, percutaneous drainage or endoscopic retrograde cholangiopancreatography) or conservative management (medical management alone). RESULTS: One hundred and seventy-four admissions of 159 individuals met inclusion criteria over the study period. The median age was 74 years (range 65 to 97), with 98 (61.6%) male. Patients undergoing intervention (n = 94, 59.1%) were more likely to be younger (p = 0.03) and have a lower CFS score (p = 0.046) than those who were managed conservatively. CONCLUSION: In this small cohort study, frailty was associated with acute management decisions in older patients presenting with gallstone disease. Further research is required to determine the strength of association of frailty on management and outcomes and how to appropriately select older patients who would benefit from surgical intervention.

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