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Outcomes following an index emergency admission with cholecystitis
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Mytton, Jemma, Daliya, Prita, Singh, Pritam, Parsons, Simon L., Lobo, Dileep N., Lilford, Richard and Vohra, Ravinder S. (2021) Outcomes following an index emergency admission with cholecystitis. Annals of Surgery, 274 (2). pp. 367-374. doi:10.1097/SLA.0000000000003599 ISSN 0003-4932.
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Official URL: http://dx.doi.org/10.1097/SLA.0000000000003599
Abstract
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
Item Type: | Journal Article | ||||||||||||
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Subjects: | R Medicine > RC Internal medicine R Medicine > RD Surgery |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Cholecystitis, Cholecystectomy , Gallbladder -- Surgery | ||||||||||||
Journal or Publication Title: | Annals of Surgery | ||||||||||||
Publisher: | Lippincott Williams & Wilkins | ||||||||||||
ISSN: | 0003-4932 | ||||||||||||
Official Date: | 2021 | ||||||||||||
Dates: |
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Volume: | 274 | ||||||||||||
Number: | 2 | ||||||||||||
Page Range: | pp. 367-374 | ||||||||||||
DOI: | 10.1097/SLA.0000000000003599 | ||||||||||||
Status: | Peer Reviewed | ||||||||||||
Publication Status: | Published | ||||||||||||
Reuse Statement (publisher, data, author rights): | "This is a non-final version of an article published in final form in Mytton, Jemma, Daliya, Prita, Singh, Pritam, Parsons, Simon L., Lobo, Dileep N., Lilford, Richard and Vohra, Ravinder S. (2019) Outcomes following an index emergency admission with cholecystitis. Annals of Surgery . doi:10.1097/SLA.0000000000003599 (In Press) | ||||||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||||||
Description: | This paper was presented at the Annual Meeting of the Society for Academic and Research Surgery, London, January 2019 and has been published in abstract form (Br J Surg 2019; 106 (S3): 13–4). |
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Date of first compliant deposit: | 24 September 2019 | ||||||||||||
Date of first compliant Open Access: | 16 September 2020 | ||||||||||||
RIOXX Funder/Project Grant: |
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