Skip Navigation LinksHome > January 2013 - Volume 74 - Issue 1 > A population-based analysis of the clinical course of 10,304...
Journal of Trauma and Acute Care Surgery:
doi: 10.1097/TA.0b013e3182788e4d
CME Articles

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

Continued Medical Education
Editor's Choice
Collapse Box

Abstract

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.

© 2013 Lippincott Williams & Wilkins, Inc.

Follow Us


Login

Article Tools

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.