Factors Influencing Early Postoperative Recovery in Older Patients Undergoing Laparoscopic Cholecystectomy

Abstract

Introduction Cholecystectomy is a common surgical procedure in older adults. Postoperative recovery may be complicated by various factors, including surgical wound pain and abdominal distension. Additionally, age-related physiological decline in older adults can contribute to delayed recovery following surgery. Currently, there is a lack of research in Thailand examining the factors that influence early recovery in older patients undergoing laparoscopic cholecystectomy (LC). 

Objective This study aims to investigate the factors affecting early recovery in older patients undergoing laparoscopic cholecystectomy. 

Design This study employs a descriptive research design using secondary data analysis. A random sampling method was used to select older patients who underwent laparoscopic cholecystectomy during the study period. The research is guided by the Theory of Transition, which conceptualizes recovery as a transition from illness to well-being. Early postoperative outcomes following laparoscopic cholecystectomy are considered an outcome of this transitional process. Early recovery depends on both individual and treatment-related factors, including age, gender, and body mass index (BMI), American Society of Anesthesiologists (ASA) classification, smoking status, comorbidities, use of anticoagulant medications, presence of cholecystitis, duration of surgery and anesthesia, hematological test results, and postoperative outcomes.

Methods The study participants consisted of 229 older patients who underwent laparoscopic cholecystectomy at a hospital in an eastern province of Thailand, between 2016 and 2024. Through random sampling using statistical software, participants were recruited. Data were collected from medical records using a record form developed by the researchers, which demonstrated a content validity index (CVI) of .80. Test retest reliability was .97, while inter-rater reliability was .95. Factors influencing early recovery in older patients following laparoscopic cholecystectomy were analyzed using univariate analysis and binary logistic regression, with a statistical significance level set at .05.

Results A total of 229 patients were included in the study, with a mean age of 68.0 years (SD = 6.6; Min-Max = 60–90 years) and a mean body mass index (BMI) of 25.0 kg/m² (SD = 4.4). Of these, 64.2% were female; 45.0% had chronic cholecystitis; 93.0% had comorbidities; 36.2% had complications; 13.5% underwent emergency surgery; 64.2% were classified as ASA Grade 2. The median duration of surgery was 90 minutes (Q1-Q3 = 70–115 minutes). Conversion to open abdominal surgery was required in 1.31%. Intraoperative adverse events occurred in 21.0% of the patients, with bradycardia (heart rate <50 bpm) being the most common (15.3%). Surgical drain placement was performed in 20.1%. Patients were categorized into two groups based on recovery time: those with early recovery (hospital stay ≤3 days) and those with delayed recovery (hospital stay >3 days), accounting for 68.1% and 31.9% of the patients, respectively. Factors significantly associated with delayed recovery, identified through both univariate analysis and binary logistic regression, included: 1) emergency surgery (Adjusted OR [95% CI]: -6.17 [-9.24 to -3.09], p < .001), 2) surgical drain placement (Adjusted OR [95% CI]: -1.99 [-3.46 to -0.51], p = .008), 3) platelet count <150 × 10³/mm³ (Adjusted OR [95% CI]: -3.19 [-5.26 to -1.13], p = .002), 4) use of oral analgesics (Adjusted OR [95% CI]: -1.34 [-2.36 to -0.32], p = .010), and 5) presence of postoperative complications (Adjusted OR [95% CI]: -1.81 [-2.82 to -0.80], p < .001).

Recommendation Older people with gallbladder-related conditions should be proactively managed to prevent emergency surgery, including scheduling elective surgery before the onset of severe symptoms. Prior to laparoscopic cholecystectomy, platelet levels should be assessed and any thrombocytopenia addressed. Postoperatively, if a surgical drain is placed and oral analgesics are administered, a comprehensive care plan should be implemented. This plan should include pain management, assistance with sitting and mobilization, and appropriate measures to prevent postoperative complications. Such interventions are essential to promote early recovery in older patients.