Long-Term Mortality After Cholecystectomy in a Nationwide Cohort of Swedish Individuals Between 1969 and 2016

Few studies have reported overall and subgroup long-term survival after cholecystectomy.

Linking gallbladder histopathology reports from all of Sweden's 28 pathology departments to the Swedish Patient Register, we identified 159,946 adults 20-79 years of age with incident cholecystectomy between 1969 and 2016. Each patient was age- and sex- matched to 5 general population reference individuals (N = 764,681). Cox regression hazard ratios were conditioned on matching factors and additionally adjusted for type 2 diabetes, obesity, ischemic heart disease, chronic obstructive pulmonary disease, alcohol-related diseases, and education.

During a median follow-up of 12 years, we identified 38,401 deaths (18.5 deaths per 1000 person-years [PY]) among cholecystectomy participants and 181,197 deaths in reference individuals (18.4 per 1000 PY). This corresponded to an adjusted hazard ratio (aHR) of 0.91 (95% confidence interval [CI], 0.90-0.92) for overall mortality, and low cardiovascular mortality (aHR, 0.85; 95% CI, 0.83-0.86), which highly heterogeneous by age. Cholecystectomy was associated with higher mortality in individuals 20-39 years of age, with absolute mortality rates of 2.1 (95% CI, 1.9-2.2) in cholecystectomy participants vs 1.4 (95% CI, 1.3-1.4) per 1000 PY in reference individuals. Alcohol-related disease (12.2%) and smoking-related disorders (7.4%) were common among the 1015 patients diagnosed at 20-39 years of age who died during follow-up. Individuals >50 years of age undergoing cholecystectomy had a lower relative risk of overall and cardiovascular mortality. Cholecystectomy was not associated with cancer mortality (aHR, 1.01; 95% CI, 0.99-1.03).

In a nationwide, Swedish cohort, we observed that cholecystectomy at younger age was associated with higher long-term mortality, potentially influenced by higher alcohol use and smoking. The inverse association among individuals >50 years of age may reflect better underlying health of individuals selected for cholecystectomy.