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A population-based analysis of the clinical course of 10,304 patients with acute cholecystitis, discharged without cholecystectomy

de Mestral, Charles MD; Rotstein, Ori D. MD, MSc; Laupacis, Andreas MD, MSc; Hoch, Jeffrey S. MA, PhD; Zagorski, Brandon MS; Nathens, Avery B. MD, PhD, MPH

Journal of Trauma and Acute Care Surgery: January 2013 - Volume 74 - Issue 1 - p 26–31
doi: 10.1097/TA.0b013e3182788e4d
CME Articles
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BACKGROUND Randomized trials and expert opinion support early laparoscopic cholecystectomy for most patients with acute cholecystitis (AC); however, practice patterns remain variable worldwide, and delayed cholecystectomy remains a common practice. We therefore present a population-based analysis of the clinical course of patients with AC discharged without cholecystectomy.

METHODS Using administrative databases capturing all emergency department (ED) visits and hospital admissions within a geographic region encompassing 13 million persons, we identified adults with a first emergency admission for uncomplicated AC during the period of 2004 to 2011. In those discharged without cholecystectomy, the probability of a subsequent gallstone-related event (gallstone-related ED visit or hospital admission) was evaluated using Kaplan-Meier methods. The association of patient characteristics with time to first gallstone-related event after discharge was explored through multivariable time to event analysis.

RESULTS Of 25,397 patients with AC, 10,304 (41%) did not undergo cholecystectomy on first admission. The probability of a gallstone-related event by 6 weeks, 12 weeks, and 1 year after discharge was 14%, 19%, and 29% respectively. Of these events, 30% were for biliary tract obstruction or pancreatitis. When controlling for sex, income, and comorbidity level, the risk of a gallstone-related event was highest for patients 18 years to 34 years old.

CONCLUSION For patients who do not undergo cholecystectomy on first admission for AC, the probability of a gallstone-related ED visit or hospital admission within 12 weeks of discharge is 19%. The increased risk in younger patients reinforces the value of early cholecystectomy in the nonelderly.

LEVEL OF EVIDENCE Prognostic study, level III; therapeutic study, level IV.

From the Li Ka Shing Knowledge Institute (C.D.M., O.D.R., A.L., J.S.H., A.B.N.), St Michael’s Hospital; and Institute for Clinical Evaluative Science (C.D.M., A.L., J.S.H., B.Z., A.B.N.), Toronto, Ontario, Canada.

Submitted: August 1, 2012, Revised: August 22, 2012, Accepted: August 23, 2012.

The study was presented at the 71st annual meeting of the American Association for the Surgery of Trauma, September 12–15, 2012, in Kauai, Hawaii.

Address for reprints: Dr. Charles de Mestral, 30 Bond St, Queen Wing 3-076, Toronto, ON, Canada, M5B 1W8; email: charles.demestral@mail.utoronto.ca.

© 2013 Lippincott Williams & Wilkins, Inc.