Comprehensive assessment of the management of acute cholecystitis in Scotland: population-wide cohort study

Abstract

Background Acute cholecystitis is one of the most common diagnoses presenting to emergency general surgery and is managed either operatively or conservatively. However, operative rates vary widely across the world. This real-world population analysis aimed to describe the current clinical management and outcomes of patients with acute cholecystitis across Scotland, UK. Methods This was a national cohort study using data obtained from Information Services Division, Scotland. All adult patients with the admission diagnostic code for acute cholecystitis were included. Data were used to identify all patients admitted to Scottish hospitals between 1997 and 2019 and outcomes tracked for inpatients or after discharge through the unique patient identifier. This was linked to death data, including date of death. Results A total of 47 558 patients were diagnosed with 58 824 episodes of acute cholecystitis (with 27.2 per cent of patients experiencing more than one episode) in 46 Scottish hospitals. Median age was 58 years (interquartile range (i.q.r.) 43–71), 64.4 per cent were female, and most (76.1 per cent) had no comorbidities. A total of 28 741 (60.4 per cent) patients had an operative intervention during the index admission. Patients who had an operation during their index admission had a lower risk of 90-day mortality compared with non-operative management (OR 0.62, 95% c.i. 0.55–0.70). Conclusion In this study, 60 per cent of patients had an index cholecystectomy. Patients who underwent surgery had a better survival rate compared with those managed conservatively, further advocating for an operative approach in this cohort.

Tendência da mortalidade por colecistite no Nordeste brasileiro, de 2013 a 2022

“…Um estudo realizado por Aguiar et al (2022) demostrou a relação entre o sexo feminino e a maior propensão em manifestar complicações relacionadas à cálculos biliares, como a colecistite aguda. Outro estudo realizado a partir de dados de 47.558 pacientes escoceses constatou que 64,4% dos episódios relatados de colecistite aguda advinham de pacientes femininas (Bekheit et al, 2023). Esse achado pode estar atrelado ao fato de que mulheres apresentam risco três vezes maior de desenvolvimento de cálculos biliares devido ao hormônio sexual estrogênio (Novacek, 2006).…”