Safety of Cholecystectomy in Nonagenarians: A Systematic Review and Meta-Analysis.

Background/Objectives: To evaluate the safety of cholecystectomy in nonagenarians. Methods: In compliance with the PRISMA statement standards, a systematic review including random-effects meta-analysis and meta-regression models was conducted. All studies reporting postoperative outcomes in patients aged ≥90 undergoing cholecystectomy were included and analyzed. Results: Six studies (1223 patients) were included. The risk of 30-day mortality was 5.4% (95% CI 3.1-7.7); 30-day morbidity occurred in 22% (95% CI 11.3-32.8). The mean length of hospital stay was 11.5 days (95% CI 8.3-14.6). Postoperative mortality was not affected by male sex (coefficient: 0.028, p = 0.832), ASA status ≥ III (coefficient: 0.051, p = 0.309), cholecystitis as indication for cholecystectomy (coefficient: -0.166, p = 0.051), cholecystectomy in emergency setting (coefficient: -0.020, p = 0.425), laparoscopic (coefficient: -0.104, p = 0.09) or open approach (coefficient: 0.104, p = 0.09), and conversion to open surgery (coefficient: 0.043, p = 0.820). The GRADE certainty of evidence was low to moderate. Conclusions: Subject to selection bias and confounding by fitness, the available evidence suggests that cholecystectomy in highly selected nonagenarians with good performance status, who have passed robust preoperative fitness assessment tests, may be safe with an acceptable risk of morbidity and mortality.