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Factors Affecting Early Cholecystectomy for Acute Cholecystitis in Older People-A Population-Based Study
Jakob K Köstenbauer1,2, Robert C Gandy3,4, Jacqueline Close5,4
1Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, 2065, Australia. Jakob.koestenbauer@health.nsw.gov.au.
Insights
Early cholecystectomy (within 7 days) is common in older Australian patients with acute cholecystitis. This approach is safe and effective, leading to better outcomes like shorter hospital stays and fewer complications.
Area of Science:
- Surgical outcomes
- Gastroenterology
- Public health
Background:
- Acute cholecystitis is a frequent surgical emergency in Australia, particularly in older adults.
- Current guidelines advocate for early laparoscopic cholecystectomy (within 7 days) to improve patient outcomes and reduce healthcare costs.
- Concerns exist regarding potential increased morbidity and conversion rates to open surgery with early intervention in elderly patients.
Purpose of the Study:
- To determine the proportion of early versus delayed cholecystectomies in patients over 50 with acute cholecystitis in New South Wales (NSW).
- To compare health outcomes between early and delayed surgery groups.
- To identify factors influencing the timing of cholecystectomy in this demographic.
Main Methods:
- Retrospective population-based cohort study.
- Analysis of 47,478 cholecystectomies for acute cholecystitis in NSW residents aged over 50 (2009-2019).
- Multilevel multivariable logistic regression models adjusted for patient and hospital factors.
Main Results:
- 85% of cholecystectomies were performed within 7 days of admission.
- Delayed surgery was linked to older age, comorbidities, male sex, Medicare-only insurance, and lower-volume surgical centers.
- Early surgery correlated with shorter length of stay, reduced readmissions, less conversion to open surgery, and lower bile duct injury rates.
Conclusions:
- A high rate of early cholecystectomy is being achieved for older adults with acute cholecystitis in NSW.
- The findings support the effectiveness and safety of early cholecystectomy in this patient group.
- Identified factors may inform healthcare professionals and policymakers to optimize surgical timing and improve patient care.
Objectives:
Acute cholecystitis is one of the most common surgical presentations in Australia and increases with age. Guidelines recommend early laparoscopic cholecystectomy (within 7 days), as it results in shorter length of stay, reduced costs and readmission rates. Despite this, there is a perception that early cholecystectomy may result in higher morbidity and conversion to open surgery in older patients. Our objective is to report the proportion of early versus delayed cholecystectomy in older patients in New South Wales (NSW), Australia, and to compare health outcomes and factors influencing variation.
Design:
This is a retrospective population-based cohort study of all cholecystectomies for primary acute cholecystitis in NSW residents aged >50, between 2009 and 2019. The primary outcome was the proportion of early versus delayed cholecystectomy. We used multilevel multivariable logistic regression analyses adjusted for age, sex, comorbidities, insurance status, socio-economic status and hospital characteristics.
Results:
A high rate (85%) of the 47,478 cholecystectomies in older patients were performed within 7 days of admission. Delayed surgery was associated with increasing age and comorbidity, male sex, Medicare-only insurance and surgery in low- or medium-volume centres. Early surgery was associated with shorter overall length of stay, fewer readmissions, less conversion to open surgery and lower bile duct injury rates.
Conclusion:
A high proportion of adults with cholecystitis are undergoing early cholecystectomy in NSW. Our results support the efficacy of early cholecystectomy in older patients and identify potentially modifiable factors relevant to health care professionals and policymakers.
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