K.S.CHAN1, R.MOHAN2, J.K.LOW3, S.P.JUNNARKAR3, C.W.T.HUEY3, V.G.SHELAT3
MOH Holdings Pte Ltd (MOHH)1, National University of Singapore2, Tan Tock Seng Hospital3
Old age ≥75 years old forms part of the criteria for moderate (grade II) severity acute cholangitis (AC) in the Tokyo Guidelines. Old age is associated with reduction in vital capacity and physiological reserves. Recent studies demonstrate safety of endoscopic retrograde cholangiopancreatogram (ERCP) in older patients. We hypothesis that outcomes of AC are comparable between older and younger patients.
This is a retrospective study on all patients with AC from January 2016-December 2016. Older patients were defined as ≥80 years old. Data on clinical profile, treatment received and outcomes (length of stay and mortality) were collected. A 1:1 propensity score matching (PSM) was done for factors predictive of outcomes and variables statistically significantly different between the study groups. Chi-square test and Mann-Whitney U test were used for analysis.
There were 457 patients (older n=318 (69.6%), younger n=139 (30.4%)). 52.5% had history of biliary disease. 43.3% and 27.6% had AC grade II and III respectively. Overall in-hospital mortality and 30-d mortality was 4.6% and 7.4% respectively. PSM resulted in 224 patients (older n=112, younger n=112). In the matched cohort, incidence of ERCP was comparable, while older patients were more likely to undergo percutaneous transhepatic biliary drainage (n=13 (11.16%) vs n=5 (4.5%), p=0.049). Length of stay, in-hospital mortality and 30-day mortality were comparable in both the unmatched and matched cohorts.
Morbidity and mortality are comparable between older (≥80 years) and younger patients. Age alone may not predict the outcomes of AC and its use in the Tokyo Guidelines should be re-evaluated.