A recent population-based study examined the recurrence of gallstone complications following nonoperative management of acute cholecystitis.
Investigators analyzed records from 1,634 patients treated at 3 Swedish hospitals between 2017 and 2020, focusing on 909 patients managed nonoperatively.
Published in BMJ Open Gastroenterology, the study revealed that 38.3% (n = 348) of patients experienced new gallstone complications following nonoperative management (NOM), with a median time to recurrence of 82 days. Notably, 27% of recurrences occurred within 30 days, and 17% between 31 and 60 days. Younger patients with their first gallstone complication had a lower risk of new complications compared with those who had a history of gallstone issues, whereas older patients showed no statistically significant difference in relapse risk but were more likely to be readmitted.
"Delayed cholecystectomy should be prioritized for younger patients with a history of gallstone disease if early cholecystectomy is not feasible. Delayed cholecystectomy should be scheduled without a prior outpatient clinic visit to minimize delays," noted lead study author Louise Helenius, of the Department of Surgery at Gävle Sjukhus Hospital, and colleagues.
The investigators linked patient records to the National Gallstone Surgery registry, allowing for a comprehensive analysis and adjustment for multiple variables using Cox proportional hazards regression. They found that 16% of patients required readmission within 30 days of discharge, with older and comorbid patients at higher risk. The NOM group was older and had more comorbidities compared with those who underwent early surgery, with 239 patients (26.3%) having a history of previous gallstone disease.
The health care system should strive for early cholecystectomy in most patients, particularly those with fewer comorbidities, to reduce the risk of recurrent gallstone complications, noted investigators. The current practice of delayed cholecystectomy often results in longer wait times and an increased risk of complications.
The authors reported no conflicts of interest.