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Symptomatic cholelithiasis: a different disease in men? Connecticut Laparoscopic Cholesystectomy Registry
J C Russell1, S J Walsh, L Reed-Fourquet
1Connecticut Society of American Board Surgeons, Wallingford, USA.
Objective:
To determine the importance of gender in the clinical presentation and subsequent clinical outcome (risk of conversion from laparoscopic to open technique and risk of postoperative mortality) for patients undergoing cholecystectomy.
Summary Background Data:
Age and clinical presentation have consistently been found to be important predictors of cholecystectomy outcomes; male gender has been cited in disparate studies as possibly having prognostic significance.
Method:
A statewide cholecystectomy registry (30,145 cases between 1989-1993) was analyzed. Hierarchical log-linear modeling was used to identify associations between characteristics of clinical presentation. Multivariate logistic regression analysis was used to determine predictions of conversion and mortality.
Results:
Male gender was associated with twice the expected incidence of acute cholecystitis and pancreatitis in the elderly (> or = 65 years). Males had a significantly increased risk for conversion to open technique, but this decreased during the time frame of the study. Mortality was twice as high among males (confidence interval, 1.4-2.9, p = 0.0001).
Conclusions:
Males presenting for cholecystectomy are more likely to have severe disease. Independent of clinical presentation, they face increased risks of conversion to open technique and of postoperative mortality.