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Immediate Removal of Inflamed Gallbladder Improves Outcome in Elderly
In seniors who experience acute inflammation of the gallbladder (cholecystitis), removing it quickly after the onset of the initial inflammation leads to significantly better prognosis over the long term. Not only were mortality and the number of re-hospitalizations reduced when it was removed, but the researchers also found that the long term financial cost was cut considerably.
Researchers at the University of Texas Medical Branch in Galveston reviewed data from almost 30,000 patients (average age: 77) who had been hospitalized for sudden inflammation of the gallbladder. Three quarters of the patients had undergone an immediate cholecystectomy (gall bladder removal); the other quarter of the participants did not have surgery. In the two years following the initial hospitalization, 38% of the people who had not received surgery were readmitted for additional gallbladder problems. For people who had undergone the surgery, the readmission rate was only 4%.
The researchers also discovered that about 27% of the group that had not undergone surgery had to go back have their gallbladders removed in the next two years. Even worse, their risk for death in these two years was 56% higher than for the patients who’d had the surgery, even when other health issues were taken into consideration.
There was also a financial cost associated with not having had the surgery at the time of the initial inflammation. Being readmitted to the hospital for a second episode of gallbladder inflammation cost an average of $14,000, which included $7,000 in Medicare payments (all participants in the study were Medicare beneficiaries).
The study points to some important advantages of having the surgery soon after the initial inflammation, if the patient is able to undergo it. The authors sum of their findings by saying that “[c]holecystectomy should be performed during initial hospitalization for acute cholecystitis to prevent recurrent episodes of cholecystitis, multiple readmissions, and increased costs... Additional studies will allow us to further assess the appropriateness and timing of gallbladder surgery in the elderly, improving health care decision making for the most common abdominal surgical disease occurring in this age group.”
The study was published in the May 2010 issue of the Journal of the American College of Surgeons.
June 13, 2010
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