Outcomes Following an Index Emergency Admission With Cholecystitis: A National Cohort Study.

Tytuł:: Outcomes Following an Index Emergency Admission With Cholecystitis: A National Cohort Study.
Autorzy:: Mytton J; Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
Daliya P; Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK.
Singh P; Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Parsons SL; Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK.
Lobo DN; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK.; MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Lilford R; Warwick Medical School, University of Warwick, Coventry, UK.
Vohra RS; Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Nottingham, UK.
Źródło:: Annals of surgery [Ann Surg] 2021 Aug 01; Vol. 274 (2), pp. 367-374.
Typ publikacji:: Journal Article; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Original Publication: Philadelphia, PA : Lippincott Williams & Wilkins
MeSH Terms:: Cholecystectomy*
Conservative Treatment*
Cholecystitis, Acute/*therapy
Cholecystitis, Acute/mortality ; Emergencies ; England/epidemiology ; Female ; Hospitalization/statistics & numerical data ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; State Medicine ; Wales/epidemiology
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Grant Information:: MR/P021220/1 United Kingdom MRC_ Medical Research Council; MR/K00414X/1 United Kingdom MRC_ Medical Research Council; 19891 United Kingdom ARC_ Arthritis Research UK
Entry Date(s):: Date Created: 20191001 Date Completed: 20210914 Latest Revision: 20230923
Update Code:: 20240105
DOI:: 10.1097/SLA.0000000000003599
PMID:: 31567508
: Czasopismo naukowe

Objective: The objective of this study was to evaluate the differences between patients who undergo cholecystectomy following index admission for cholecystitis, and those who are managed nonoperatively.
Summary Background Data: Index emergency cholecystectomy following acute cholecystitis is widely recommended by national guidelines, but its effect on clinical outcomes remains uncertain.
Methods: Data collected routinely from the Hospital Episode Statistics database (all admissions to National Health Service organizations in England and Wales) were extracted between April 1, 2002 and March 31, 2015. Analyses were limited to patients aged over 18 years with a primary diagnosis of cholecystitis. Exclusions included records with missing or invalid datasets, patients who had previously undergone a cholecystectomy, patients who had died without a cholecystectomy, and those undergoing cholecystectomy for malignancy, pancreatitis, or choledocholithiasis. Patients were grouped as either "no cholecystectomy" where they had never undergone a cholecystectomy following discharge, or "cholecystectomy." The latter group was then subdivided as "emergency cholecystectomy" when cholecystectomy was performed during their index emergency admission, or "interval cholecystectomy" when a cholecystectomy was performed within 12 months following a subsequent (emergency or elective) admission. Propensity Score Matching was used to match emergency and interval cholecystectomy groups. Main outcome measures included 1) One-year total length of hospital stay due to biliary causes following an index emergency admission with cholecystitis. 2) One-year mortality; defined as death occurring within 1 year following the index emergency admission with acute cholecystitis.
Results: Of the 99,139 patients admitted as an emergency with acute cholecystitis, 51.1% (47,626) did not undergo a cholecystectomy within 1 year of index admission. These patients were older, with more comorbidities (Charlson Comorbidity Score ≥ 5 in 23.5% vs. 8.1%, P < 0.001) when compared to patients who did have a cholecystectomy. While all-cause 1-year mortality was higher in the nonoperated versus the operated group (12.2% vs. 2.0%, P < 0.001), gallbladder-related deaths were significantly lower than all other causes of death in the non-operated group (3.3% vs. 8.9%, P < 0.001). Following matching, 1-year total hospital admission time was significantly higher following emergency compared with interval cholecystectomy (17.7 d vs. 13 d, P < 0.001).
Conclusions: Over 50% of patients in England did not undergo cholecystectomy following index admission for acute cholecystitis. Mortality was higher in the nonoperated group, which was mostly due to non-gallbladder pathologies but total hospital admission time for biliary causes was lower over 12 months. Increasing the numbers of emergency cholecystectomy may risk over-treating patients with acute cholecystitis and increasing their time spent admitted to hospital.
Competing Interests: The authors report no conflicts of interest.
(Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc.)

Comment in: Ann Surg. 2021 Dec 1;274(6):e780. (PMID: 32941282)

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