A nationwide study of over 32,000 older adult patients with multiple chronic conditions found that surgery for acute cholecystitis may be linked to fewer hospital readmissions, fewer emergency department visits, and lower health care costs within 90 days compared with nonoperative care.
Investigators analyzed data from 32,527 Medicare beneficiaries aged 65.5 years and older who were hospitalized for acute cholecystitis between 2016 and 2018. All patients met criteria for multimorbidity—specific combinations of chronic conditions associated with increased surgical risk. The investigators compared outcomes between patients who underwent cholecystectomy during their hospital stay and those managed nonoperatively.
Among the patients, 66.8% received operative treatment, whereas 33.2% received nonoperative care. Among the nonoperative group, 32.1% were treated with a percutaneous cholecystostomy tube.
Using adjusted statistical models, the investigators found significantly lower 30- and 90-day readmission rates in the surgical group. Thirty-day readmissions occurred in 17.3% of the patients in the operative group vs 29.9% of those in the nonoperative group. At 90 days, rates were 24.3% and 43.6%, respectively.
Emergency department (ED) revisits followed a similar pattern. Within 30 days, 12.3% of surgical patients returned to the ED compared with 19.6% of nonoperative patients. At 90 days, revisit rates were 19.5% and 31.3%, respectively.
Mortality was also lower in the operative group. At 30 days, mortality was 3.7% among surgical patients compared with 10.2% among those managed nonoperatively. At 90 days, rates were 6.3% and 16.8%, respectively.
Although the initial hospitalization costs were higher for surgery—$11,055 compared with $7,798—surgery was more cost effective over time. By 90 days, the cumulative costs were $16,461 among surgical patients and $15,804 among nonoperative patients. At 180 days, the operative group had lower total costs: $18,061 vs $18,801.
To assess outcomes among patients where the decision to operate was less clear, the investigators conducted a separate analysis using an instrumental variable based on surgeon preference. Among these patients—those in clinical equipoise—mortality rates were similar between the groups, but surgical patients continued to have fewer readmissions and ED visits.
The investigators used Medicare claims data to track procedures, outcomes, and costs. Most patients were evaluated with ultrasound (71.9%) or computed tomography (64.9%).
The investigators concluded that surgery for acute cholecystitis may be associated with improved short-term outcomes and reduced health care use over time among older adults with multimorbidity. They concluded: “Operative treatment was associated with decreased rates of 30- and 90-day hospital readmission and ED revisitation.”
Full disclosures are available in the original study.
Source: JAMA Surgery