Risk Not a Factor in Gall Bladder Removal Decision

A new study reveals that the use of elective cholecystectomy in older patients is independent of their risk of developing complications.

Researchers at the University of Texas Medical Branch (UTMB; Galveston, USA) conducted a study to validate a prognostic model that accurately predicts the two-year risk of emergent gallstone-related hospitalization in older patients. To do so, they identified Texas Medicare patients 66 and older with initial episode of symptomatic gallstones not requiring emergency hospitalization. The patients were placed into three tercile risk groups, based on model estimates. Within each risk group, they calculated the percent of elective cholecystectomies performed.

The results showed that 161,568 patients had an episode of symptomatic gallstones. For the overall cohort, removal of the gallbladder did not seem to depend on risk, with less than 25% of patients in all risk groups undergoing elective cholecystectomy in the 2.5 months after the initial episode. And while according to the predictive model, the patients in the highest risk category should be receiving gallbladder removal surgery most often, the study revealed the reverse to be true; in the healthiest patients, those with the highest risk had their gallbladders removed least often. The study was published in the January 2015 edition of the Journal of the American College of Surgeons.

“The risk of recurrent acute biliary symptoms requiring hospitalization has no influence, or even a paradoxical negative influence, on the decision to perform elective cholecystectomy after an initial symptomatic episode,” concluded lead author Professor of Surgery Taylor Riall, MD. “Translation of the risk prediction model into clinical practice can better align treatment with risk and improve outcomes in older patients with symptomatic gallstones.”

The risk of developing gallstones increases with age. While a person under 40 has about an 8% chance of developing gallstones, the risk jumps to more than 50% in people 70 years and older. Gallbladder disease is the most common cause of acute abdominal pain in older patients and removal of the gallbladder accounts for a third of abdominal operations in patients over 65.

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University of Texas Medical Branch