Immediate Treatment for Elderly Patients with Cholecystitis

Delaying removal of the gallbladder results in increased costs, morbidity, and mortality, researchers have found.

In elderly patients who are suffering from a sudden inflammation of the gallbladder, delaying removal of the organ results in increased costs, morbidity, and mortality, according to a new study from researchers at the University of Texas Medical Branch (UTMB).

Taylor S. Riall, MD, PhD, FACS, associate professor of surgery at UTMB, and the team of researchers examined data from 29,818 Medicare beneficiaries who were admitted to an acute care hospital for acute cholecystitis. Of the 75% who underwent cholecystectomy, the inpatient mortality rate was 2.1%, compared to 2.7% for patients who did not have their gallbladder removed. Among the 25% of patients who did not have a cholecystectomy during their first hospitalization, 38% were re-admitted to the hospital for gallstone-related issues within the next two years, and 27% of patients who did not have “definitive therapy”—gallbladder removal—during their first hospitalization later required cholecystectomy that was often associated with an acute care re-admission.

The researchers also examined the financial burden of a delayed cholecystectomy and eventual mortality. Gallstone-related readmissions “were expensive for Medicare, leading to approximately $14,000 in total charges and greater than $7,000 in Medicare payments per readmission.” Patients who did not undergo a cholecystectomy during their first hospitalization were 56% more likely to die 2 years after discharge, compared to those who received immediate treatment. This disparity remained even after controlling for patient demographics and comorbidities.

The researchers also note that the prevalence of gallstones increases with age—5% of men and 24% of women will have gallstones by age 70 years—and complications related to gallstones, the most common of which is acute cholecystitis, are also more common in elderly patients.

Riall hopes the results of the study will help physicians treat gallbladder problems more effectively. "This is the first systematic study on how adherence to the recommendations for management of acute cholecystitis affects long-term outcomes and resource use," he said. "Our study helped identify both patients who are at high risk for not receiving definitive surgical treatment with cholecystectomy and those that are at high risk for being readmitted if they do not have cholecystectomy."

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