Prompt Gallbladder Removal in Elders Associated With Increased Survival, Lower Costs

New research findings published in the Journal of the American College of Surgeons indicate that delaying cholecystectomy, the surgical removal of the gallbladder, in elders with sudden inflammation of the organ often results in increased costs, morbidity, and mortality.

"This is the first systematic study on how adherence to the recommendations for management of acute cholecystitis affects long-term outcomes and resource use," says Taylor S. Riall, MD, PhD, FACS, an associate professor of surgery at the University of Texas Medical Branch in Galveston. "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."

Researchers used a 5% of national Medicare claims data from 1996 to 2005 to identify a cohort of patients admitted to an acute care hospital with acute cholecystitis. By choosing patients from this period, researchers were able to evaluate comorbidities in the year before initial hospitalization and then follow all patients two years after their initial hospitalization for gallstone complications.

Between 1996 and 2005, 29,818 Medicare beneficiaries were admitted to acute care facilities for a first episode of acute cholecystitis. Of these patients, 75% (n=22,367) underwent cholecystectomy. The inpatient mortality rate was 2.7% in patients who did not undergo cholecystectomy, and 2.1% in patients who did (p = 0.001).

For the 25% of patients (n=7,451) who did not undergo cholecystectomy upon first hospitalization, 38% required gallstone related readmission over the subsequent two years, compared with only 4% in patients who did undergo the surgery (P< 0.0001). Twenty-seven percent of patients who did not undergo definitive therapy (gallbladder removal) required subsequent cholecystectomy, often not performed electively, but associated with acute care readmission. The 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.

Additionally, patients who did not undergo cholecystectomy during initial hospitalization were 56% more likely to die two years after hospitalization discharge vs. those who received immediate treatment, even after controlling for patient demographics and comorbidities.

Source: Weber Shandwick Worldwide