Surgery · Gastroenterology ·
Gallstone complications recur after non-operative management, Swedish registry study finds
A nationwide Swedish registry cohort study followed 82,101 patients admitted with acute gallstone complications and managed without surgery between 2006 and 2019. Recurrence remained common over three years, while mortality was high among patients aged 80 years or older.
- Three-year recurrence ranged from 19.8% to 23.0%.
- Cholangitis and pancreatitis had higher recurrence risk than cholecystitis.
- Three-year mortality was 41.2% among patients aged 80 or older.
- The registry study did not compare surgery with non-operative care.
Researchers used the Swedish National Patient Register to identify 82,101 patients admitted with acute cholecystitis, cholangitis, or biliary pancreatitis who received non-operative management from 2006 to 2019. Median age was 68 years, and 48% were female. Competing-risk and Cox models assessed recurrence and mortality, accounting for death from other causes.
At one year, cumulative recurrence risk was 16.0% across the three conditions. At three years, it was 19.8% after cholecystitis, 23.0% after cholangitis, and 22.5% after pancreatitis. Compared with cholecystitis, cholangitis and pancreatitis were associated with greater recurrence risk among patients alive (hazard ratios 1.22 and 1.28, respectively). Among patients aged 80 years or older, three-year mortality was 41.2%; 17.0% of deaths were gallstone-related.
The findings show that recurrence remains a relevant concern despite competing mortality, including in older and comorbid patients. The authors say the results support considering early cholecystectomy when operative risk is acceptable. Because this registry study examined patients managed non-operatively and did not directly compare outcomes with surgery, it cannot establish the benefit of surgery for an individual patient.
In practice
For patients admitted with acute cholecystitis, cholangitis, or biliary pancreatitis who are managed without surgery, recurrence remains clinically important: the three-year cumulative risk was about 20%–23%. The authors support considering early cholecystectomy when operative risk is acceptable, including in older or comorbid patients. However, this registry cohort did not compare surgery with non-operative management, so it does not establish the treatment benefit or determine the appropriate approach for an individual patient.
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BJS Open: Recurrence and mortality after non-operative management of acute gallstone disease: nationwide registry study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.