Acute Cholecystitis: Non-Operative Management vs Surgery

TOPLINE:

Among patients with acute cholecystitis who were managed non-operatively, 38.3% experienced new complications. Delayed cholecystectomy was recommended for younger patients with prior complications.

METHODOLOGY:

• Researchers conducted a retrospective study to identify risk factors for gallstone disease relapse and establish the timeline for recurrence.
• They included 1634 patients treated for acute cholecystitis at three Swedish hospitals from 2017 to 2020.
• Of these, 909 patients (mean age, 69.7 years) were managed non-operatively and 725 underwent early cholecystectomy at the time of index cholecystitis.
• The primary outcome was the occurrence of any new gallstone complications after non-operative management, assessed using patient records. Patients readmitted with symptom resurgence and elevated inflammatory marker levels were considered to have recurrent cholecystitis.
• Patients were categorised according to age, perioperative risk, comorbidities, and previous gallstone complications to assess the risk for recurrence.

TAKEAWAY:

• Of the 909 patients managed non-operatively, 38.3% experienced a new gallstone complication, with a median time to occurrence of 82 days.
• Younger patients (age, < 67 years) experiencing their first gallstone complication had a lower risk for new complications than those with prior complications. In older patients, the risk for recurrence did not differ on the basis of previous gallstone complications.
• The odds of readmission increased with higher American Society of Anesthesiologists (ASA) scores, which were used to assess perioperative risk (odds ratio, 3.32; 95% CI, 1.51-7.77 for ASA 4).
• The median time from acute cholecystitis diagnosis at index to delayed cholecystectomy was 130 days. For patients planned for surgery at discharge, the median wait time was 98 days, whereas for those scheduled at follow-up, it was 166 days.

IN PRACTICE:

“DC [delayed cholecystectomy] could be prioritised in younger patients with a history of gallstone disease if EC [early cholecystectomy] is impossible and if recurrences are the only metric; however, readmission and recurrences among elderly patients must be factored in. DC should be planned as follow-up for patients who are candidates, with the informed consent process before discharge and without prior outpatient clinic visit, to minimise the wait time for DC,” the authors wrote.

SOURCE:

The study was led by Louise Helenius, Department of Surgery, Gävle sjukhus, Gävle, Sweden. It was published online on March 18, 2025, in BMJ Open Gastroenterology.

LIMITATIONS:

The short duration of the study limited the assessment of long-term recurrence risks, with patients from 2017 having a longer follow-up than those from 2020. The lack of documentation on stone size limited the analysis of this potential risk factor. Moreover, the COVID-19 pandemic may have influenced treatment decisions.

DISCLOSURES:

The study was supported by grants from the Centre for Research and Development, Gavleborg Region. Some authors reported receiving funding from Region Gavleborg and the Swedish state under the agreement between the Swedish Government and the Uppsala County Council. Open access funding was received from Uppsala University. No relevant conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.