To investigate the feasibility and safety of laparoscopic cholecystectomy in elderly patients on antithrombotic therapy.

According to the inclusion and exclusion criteria, 60 elderly patients with acute cholecystitis with or without cholecystolithiasis admitted to Department of Gastrointestinal Pancreatic Surgery Department of Jiangning Hospital Affiliated to Nanjing Medical University and Department of General Surgery of the People's Hospital of Danyang from January 2015 to December 2018 were retrospectively analyzed. All patients underwent laparoscopic surgery. According to the preoperative use of antithrombotic drugs or not, the patients were divided into either an antithrombotic therapy group (n=24) or a non-antithrombotic therapy group (n=36). The basic clinical data and intraoperative and postoperative indicators were compared between the two groups.

The ASA grade and preoperative physical status grade in the antithrombotic therapy group were significantly higher than those of the non-antithrombotic therapy group (P＜0.05 each). The proportion of patients with percutaneous coronary intervention and cerebral infarction in the antithrombotic therapy group were significantly higher than those of the non-antithrombotic therapy group (P＜0.05 each). The rate of conversion to open surgery was 8.3% in the non-antithrombotic therapy group and 12.5% in the antithrombotic therapy group, with no statistically significant difference between them (P=0.329). There was no significant differences in operative time, intraoperative blood loss, proportion of patients with 500 ml of blood loss, or intraoperative transfusion rate between the two groups (P＞0.05 each). The median length of hospital stay was longer (19 d vs 9 d, P＜0.001), and the proportion of patients admitted to the ICU after surgery was higher (37.5% vs 8.3%, P=0.012) in the antithrombotic therapy group than in the non-antithrombotic therapy group. The incidence of total postoperative complications in the antithrombotic therapy group was higher than that of the non-antithrombotic therapy group (50.0% vs 13.9%, P=0.002), but there was no significant difference in the incidence of postoperative rebleeding or deep vein thrombosis between the two groups (P＞0.05 each).

Laparoscopic cholecystitis in elderly patients on antithrombotic therapy is associated with some postoperative complications, but there is no significant difference in the risk of rebleeding and deep vein thrombosis when compared with patients not receiving antithrombotic therapy. Aggressive laparoscopic surgery can benefit elderly patients with acute cholecystitis.