European Journal of Cardiovascular Medicine

Laparoscopic cholecystectomy (Lap Chole) has largely replaced open cholecystectomy as the standard surgical approach for symptomatic gallstone disease due to its minimally invasive nature, reduced postoperative pain, shorter hospital stays, and faster recovery times compared to traditional techniques [1], [2]. The procedure is widely performed across all age groups, but differences in physiological reserves, comorbidities, and healing responses may influence postoperative outcomes, particularly in elderly patients [3].

With the increasing life expectancy and a growing elderly population, more patients aged over 60 years are undergoing laparoscopic surgeries, including Lap Chole. However, advanced age is often associated with altered pharmacodynamics, reduced tissue repair capacity, and higher susceptibility to complications such as infections, cardiovascular events, and pulmonary dysfunction [4], [5]. On the other hand, younger patients tend to recover more rapidly, with fewer complications and shorter durations of hospital stay [6].

Several studies have explored perioperative risk factors and outcomes in elderly patients undergoing Lap Chole, but limited data are available comparing detailed recovery parameters across distinct age brackets [7], [8]. Understanding these differences is crucial for tailoring perioperative management, optimizing recovery, and improving patient satisfaction in various age groups.

Therefore, this study was undertaken to assess and compare the postoperative outcomes and recovery profiles among different age groups undergoing laparoscopic cholecystectomy in a tertiary care setting.

This prospective observational study was conducted at the Department of General Surgery in a tertiary care hospital over a period of 12 months. The study aimed to compare postoperative outcomes and recovery in patients of different age groups undergoing elective laparoscopic cholecystectomy.

Study Population:
A total of 150 patients diagnosed with symptomatic cholelithiasis and scheduled for elective laparoscopic cholecystectomy were included. Patients were divided into three groups based on age:

• Group A: 18–39 years
• Group B: 40–59 years
• Group C: ≥60 years

Inclusion Criteria:

• Patients aged 18 years and above
• Diagnosed with symptomatic gallstone disease
• Fit for elective laparoscopic cholecystectomy under general anesthesia
• Provided informed written consent

Exclusion Criteria:

• Emergency cholecystectomy
• Conversion to open surgery
• Previous upper abdominal surgery
• Patients with malignancy, uncontrolled diabetes, or severe cardiopulmonary disease

Preoperative Assessment:
All patients underwent standard preoperative evaluations including blood investigations, abdominal ultrasound, chest X-ray, and ECG. Comorbidities were noted and optimized before surgery.

Surgical Procedure:
All laparoscopic cholecystectomies were performed under general anesthesia using a standard four-port technique by experienced surgeons. Operative time was measured from the first incision to final port closure.

Postoperative Monitoring:
Postoperative parameters recorded included:

• Operative time (minutes)
• Postoperative pain score (Visual Analogue Scale: 0–10) at 6 and 24 hours
• Duration of hospital stay (days)
• Time to resume normal activities (days)
• Postoperative complications (e.g., wound infection, bile leak, ileus)

Follow-Up:
Patients were followed until full recovery or up to 4 weeks post-surgery. Return to routine activity was assessed during follow-up visits or telephonic interviews.

Statistical Analysis:
Data were entered in Microsoft Excel and analyzed using SPSS version 26. Quantitative variables were expressed as mean ± standard deviation (SD), and categorical variables as percentages. One-way ANOVA was used to compare continuous variables across groups, and Chi-square test was applied for categorical data. A p-value of <0.05 was considered statistically significant.

A total of 150 patients who underwent elective laparoscopic cholecystectomy were included in the study and divided equally into three age groups: Group A (18–39 years), Group B (40–59 years), and Group C (≥60 years). The gender distribution was comparable across all groups, with a slight female predominance.

The mean operative time was significantly lower in younger patients (Group A: 48.2 ± 6.1 minutes) compared to Group B (51.4 ± 5.3 minutes) and Group C (56.8 ± 7.4 minutes). The difference was statistically significant (p = 0.01).

Postoperative pain scores assessed using the Visual Analogue Scale (VAS) at 24 hours showed lower pain levels in Group A (3.1 ± 0.6) and higher scores in Group C (4.8 ± 0.7), with a significant difference between the groups (p = 0.02).

The average duration of hospital stay was shortest in Group A (1.8 ± 0.4 days), intermediate in Group B (2.4 ± 0.5 days), and longest in Group C (3.2 ± 0.6 days), showing a statistically significant trend (p < 0.001).

Postoperative complications such as minor wound infection, ileus, and transient bile leakage were more frequent in older patients. Complication rates were 4% in Group A, 10% in Group B, and 16% in Group C (p = 0.04).

Time to resume routine activities was fastest in Group A (6.2 ± 1.1 days), followed by Group B (7.9 ± 1.4 days), and slowest in Group C (9.7 ± 1.3 days), with statistically significant differences (p < 0.001).

Table 1: Comparison of Operative and Recovery Parameters Across Age Groups

Table 1 demonstrates a clear trend of delayed recovery and higher complication rates with increasing age.

These findings indicate that younger patients recover more rapidly and experience fewer complications after laparoscopic cholecystectomy compared to older patients (Table 1).

Laparoscopic cholecystectomy has become the preferred surgical treatment for gallstone disease across all age groups due to its minimally invasive approach, reduced postoperative pain, and shorter recovery periods [1], [2]. However, the impact of age on postoperative outcomes remains a critical consideration, especially in elderly patients. This study compared outcomes among three age groups and found that increasing age was associated with longer operative times, higher pain scores, longer hospital stays, more complications, and delayed return to routine activities.

The operative time was significantly longer in older patients, consistent with previous studies that suggest age-related anatomical and physiological changes may increase surgical difficulty and duration [3], [4]. Dense adhesions, fragile tissues, and limited abdominal compliance in elderly patients may contribute to these findings [5].

Postoperative pain was significantly lower in younger patients, which could be attributed to better pain tolerance, fewer comorbidities, and more robust inflammatory responses that facilitate quicker healing [6]. Similar findings have been reported by Johna and Lee, who observed lower pain scores and faster recovery in younger individuals undergoing laparoscopic procedures [7].

The mean duration of hospital stay was shortest in Group A and progressively increased with age. Older patients often require extended monitoring due to delayed mobilization and higher risk of complications such as respiratory infections, cardiovascular instability, and delayed wound healing [8], [9]. A study by Targarona et al. also noted a significant increase in hospital stay in patients over 60 years undergoing Lap Chole [10].

Postoperative complications, although generally low in all groups, were more prevalent in elderly patients. These included wound infections, bile leakage, and transient ileus, which is in line with earlier findings that advancing age is an independent risk factor for postoperative morbidity [11], [12]. It is also worth noting that the elderly often have multiple comorbid conditions, which may compromise immune function and contribute to poor surgical outcomes [13].

The return to normal daily activities was significantly delayed in older patients. Factors such as reduced muscle mass, decreased cardiopulmonary reserve, and slower wound healing likely contribute to this delay [14]. Preoperative optimization and postoperative rehabilitation programs tailored to older individuals could potentially improve these outcomes [15].

Overall, our findings align with several previous studies and highlight the need for individualized perioperative planning in elderly patients undergoing laparoscopic cholecystectomy. While the procedure remains safe and effective across age groups, age-related factors must be carefully considered to minimize risks and enhance recovery.

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