DELIRIUM IN OLDER ADULTS UNDERGOING OPEN VERSUS MINIMALLY INVASIVE CHOLECYSTECTOMY: AN ANALYSIS OF THE 2022 NATIONAL INPATIENT SAMPLE nobuhara@stanford.edu

195-06

DELIRIUM IN OLDER ADULTS UNDERGOING OPEN VERSUS MINIMALLY INVASIVE CHOLECYSTECTOMY: AN ANALYSIS OF THE 2022 NATIONAL INPATIENT SAMPLE

4

United States

Oral or Poster

Delirium is a common postoperative complication in older adults undergoing emergency general surgery and is associated with increased rates of dementia and one-year mortality. With an aging population worldwide, cholecystectomy in patients ≥65 years is common, yet we do not understand the effect of minimally invasive surgical approaches on delirium risk.

We conducted a retrospective cohort study of adults aged ≥65 years using the 2022 National Inpatient Sample. Diagnoses of cholecystitis and delirium were identified using ICD-10 codes. Cholecystectomy was classified by ICD-10-PCS codes as open, laparoscopic, or robotic-assisted. Survey weights were applied to generate national estimates.

In this comparative analysis of 50,200 weighted older adults (≥65 years) hospitalized with cholecystitis, 13,172 (26%) underwent minimally invasive (laparoscopic or robotic) surgery, 3,574 (7%) underwent open surgery, 33,453 (67%) received non-operative management. Delirium occurred in 71 (2%) patients undergoing open cholecystectomy, compared to 132 (1%) in the minimally invasive group (p=0.01). In our multivariate model, laparoscopic and robotic surgery showed a reduced risk for delirium (aOR = 0.61, 95% CI: 0.89-1.10, p = 0.13) while patients who underwent open surgery had significantly higher odds of delirium (aOR 2.26; 95% CI: 1.16-4.39, p = 0.01). Open procedures were associated with higher mean hospitalization costs than laparoscopic procedures ($43,530 vs $21,205, p=0.002). These findings suggest increased rates of delirium and greater resource utilization in older adult patients undergoing open cholecystectomy.

Among older adults hospitalized with cholecystitis, minimally invasive cholecystectomy may be associated with lower rates of delirium compared to open surgery.