Then, using the US Bureau of Labor Statistics Medical Consumer Price Index, they were standardized to 2006 dollars [5]. 2.3. Statistical Analysis Bivariate analysis of the independent Axitinib Sigma variables by outcomes was performed using ��2 tests for categorical variables and analysis of variance (ANOVA) for continuous variables. Data analysis and management were performed using SAS version 9.1 (Cary, NC, USA). Statistical significance was set at a probability value of P �� 0.05. 3. Results Of the 1,332,195 adult admissions for biliary disease in the HCUP-NIS database between 1999 and 2006, cholecystectomy was performed as the primary procedure during hospitalization in 145,675 patients aged 50�C64 years, 149,855 patients aged 65�C79 years, and 62,561 patients aged ��80 years.

In 1999, representing the start of the study period, laparoscopic cholecystectomy was performed most frequently in patients aged between 18 and 49 years (83.5%) (Figure 1). Figure 1 Yearly trends in adoption of laparoscopic cholecystectomy by age group (1999�C2006). In contrast, laparoscopic cholecystectomy was performed less often as the age groups ascended: 50�C64 years (73.2%), 65�C79 years (65.3%) and >80 years (59.7%). During each year, there was a gradual increase in patients undergoing laparoscopic surgery across all age groups. By the end of the study period in 2006, 89.2% of patients aged 18�C49 underwent laparoscopic cholecystectomy. There was also an increase in frequency for patients aged 50�C64 years (78.9%) and 65�C79 years (73.3%). Interestingly, patients aged >80 years witnessed a marked increase from 59.

7% to 72.1%. This represented the biggest increase, of 12.4%, compared to all other age groups. 3.1. Outcomes The mortality rate in the study population undergoing open cholecystectomy increased significantly with advancing age (0.5%, 1.6%, 4.0%, and 8.3%; P < 0.001) (Table 1). Table 1 Outcomes by type of cholecystectomy procedure (laparoscopic versus open). However, mortality rates were lower in all age groups with laparoscopic cholecystectomy (0.1%, 0.3%, 0.9%, and 2.3%; P < 0.001). Patients aged ��80 years experienced a significant reduction in mortality following laparoscopic cholecystectomy (open = 8.3% versus laparoscopic = 2.3%; P < 0.001) when compared to an open procedure. There was a lower overall rate of surgical complications when comparing laparoscopic to open Carfilzomib cholecystectomy between age groups. This was most evident for patients aged 65�C79 years (open = 50% versus laparoscopic = 26.3%; P < 0.001) and ��80 years (open = 61.1% versus laparoscopic = 37.2%; P < 0.001). The trend in adoption of laparoscopic cholecystectomy was also associated with lower LOS (mean days) when compared to open cholecystectomy among all age groups.