Outcomes after cholecystectomy in patients aged ≥80 years: A National Surgical Quality Improvement Program analysis evaluating safety and risk factors for elderly patients
Bibliographic record
Abstract
BACKGROUND: Geriatric patients may be at an increased risk of complications after cholecystectomy; however, quantification of this risk is not defined. We aimed to evaluate outcomes after cholecystectomy in octogenarians and factors independently associated with complications in these patients. METHODS: This is a retrospective study of 2017 to 2021 National Surgical Quality Improvement Program data evaluating patients undergoing cholecystectomy, comparing patients aged ≥80 years with those aged <80 years. We compared demographics and outcomes with multivariable logistic regression modeling to evaluate factors independently associated with serious complications and mortality or serious complications. RESULTS: Overall, 288,705 patients were included with 4.9% being octogenarian. Octogenarians were more likely to have comorbidities, functional dependence, and lower body mass index. Octogenarians were more likely to receive open cholecystectomies (7.2% vs 2.8%; P <.001), and they had longer operative time (76.6 vs 70.2 min; P <.001) and hospital stay (4.1 vs 1.6 days; P <.001). They were also more likely to undergo reoperation (1.7% vs 0.9%; P <.001) or have serious complications (9.7% vs 2.9%; P <.001). Multivariable logistic regression demonstrated that being an octogenarian was an independent factor of increased risk of mortality (odds ratio [OR], 3.29; P <.001) and serious complications (OR, 1.54; P <.001). Specific to octogenarians, minimally invasive surgical approach was significantly protective against serious complications (OR, 0.30; P <.001) and mortality (OR, 0.29; P <.001), whereas functional dependence increased likelihood of morbidity (OR, 4.42; P <.001) and serious complications (OR, 2.08; P =.002). CONCLUSION: Octogenarians have an increased risk of morbidity after cholecystectomy. Minimally invasive surgery seems protective for these patients. Assessment of the octogenarians' functional dependence would provide insight preoperatively into their markedly increased perioperative risk.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".