Influence of gender and socioeconomic background on the decision to perform gallstone surgery: a population-based register study

Pålsson, S.; Sandblom, Gabriel

doi:10.3109/00365521.2014.978818

Cited by 18 publications

(14 citation statements)

References 24 publications

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“…The lack of change in surgery rate in men and the decreased rate in women is explained by the fact that surgery for uncomplicated gallstone disease is more common in women compared to men. 14 Over the last decade, surgery for gallstone disease has been more common in octogenarians. 15 This is probably due to an increased life expectancy in the population as well as a lower threshold for surgery in the elderly and frail.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the management of gallstone surgery: A Swedish population-based study

et al. 2022

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Background: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. Methods: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015–March 2020, was compared to the period April 2020–March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. Results: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020–March 2021 in the previous 5 years was 0.960 ( p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 ( p = 0.008), on patients aged 65–80 years was 0.964 ( p = 0.423), on patients aged >80 years was 1.336 ( p = 0.025), on men was 1.001 ( p = 0.841), on women was 0.934 ( p = 0.006), on procedures completed laparoscopically was 0.964 ( p = 0.190), on procedures completed with open approach was 0.659 ( p = 0.044), on acute procedures was 1.218 ( p = 0.016), on planned procedures was 0.791 ( p < 0.001), on procedures performed for biliary colic was 0.808 ( p < 0.001), on procedures performed for acute cholecystitis was 1.274 ( p = 0.012), for biliary pancreatitis was 1.192 ( p = 0.037), and for obstructive jaundice was 1.366 ( p = 0.008). Conclusions: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a continuation of a long-term trend toward more acute surgery remains unanswered. Further studies are needed to assess and evaluate how this has affected public health and health economics.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the management of gallstone surgery: A Swedish population-based study

et al. 2022

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“…42 Male patients were presented with more severe gallstone diseases and more frequently underwent cholecystectomy for complicated gallstones, while female patients had milder gallstone diseases and more frequently performed surgery for biliary pain. 42 Therefore, the harmful effects of complicated gallstones and risk reduction by cholecystectomy might be greater in male patients. The risk of HCC for gallstones or cholecystectomy was higher in female patients than in male patients.…”

Section: Discussionmentioning

confidence: 99%

Cholecystectomy reduces the risk of cholangiocarcinoma in patients with complicated gallstones, but has negligible effect on hepatocellular carcinoma

Ahn

Kim

Kang

et al. 2022

J of Gastro and Hepatol

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Background and Aim: Gallstones have been reported to be positively associated with hepatobiliary cancers. However, risks of these cancers by cholecystectomy or in patients with complicated gallstones are controversial. We studied the effect of cholecystectomy on the risk of cholangiocarcinoma (CCA) or hepatocellular carcinoma (HCC) in patients with gallstones and subgroup of complicated gallstones. Methods: Patients with gallstone disease (n = 958 677) and age-matched and sex-matched controls (n = 9 586 770) were identified using the Korean National Health Insurance database. Complicated gallstones were defined as gallstones associated with acute cholecystitis or acute cholangitis. Adjusted hazard ratios (adjusted hazard ratios, 95% confidence interval) of CCA and HCC incidences were evaluated in patients with gallstones who received cholecystectomy compared to the controls. We also analyzed these effects in patients with complicated gallstones. Results: Patients with gallstones showed increased risks of CCA (1.80, 1.67-1.93) and HCC (1.03, 1.00-1.07) compared with controls. Cholecystectomy had minimal effects on the risks of CCA (1.94, 1.76-2.14) and HCC (0.93, 0.87-0.99) compared with those without cholecystectomy. However, patients with complicated gallstones showed highly increased CCA risk (5.62, 4.89-6.46) and a 30% risk reduction after cholecystectomy (3.91, 3.43-4.46). Risk reduction by cholecystectomy was greater for extrahepatic CCA than for intrahepatic CCA or ampulla of Vater cancer. However, the risk of HCC was not different in patients with complicated gallstones and those who underwent cholecystectomy compared to controls. Conclusion:The risk of CCA was markedly increased in patients with complicated gallstones and was partially reduced by cholecystectomy. The risk change of HCC was minimal with gallstones or cholecystectomy.

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“…The higher likelihood of undergoing arthrodesis for female patients may be supported by the notion that these decisions are based on surgeon preference, patient expectations, and cultural factors, as well as a possibly higher association of instability with LSS that might have been underestimated by ICD-9 coding. 19 The type of procedure performed for LSS in the US elderly population has been shown to differ by geographic location. 3,23 Weinstein et al 23 reported that arthrodesis rates among elderly patients were highest in many Mid- west and Southern states compared with the Northeast and the West.…”

Section: Discussionmentioning

confidence: 99%

Trends in isolated lumbar spinal stenosis surgery among working US adults aged 40–64 years, 2010–2014

Raad

Donaldson

Dafrawy

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVERecommendations for the surgical treatment of isolated lumbar spinal stenosis (LSS) (i.e., in the absence of concomitant scoliosis or spondylolisthesis) are unclear. The aims of this study were to investigate trends in the surgical treatment of isolated LSS in US adults and determine implications for outcomes.METHODSThe authors analyzed inpatient and outpatient claims from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database for 20,279 patients aged 40–64 years who underwent surgery for LSS between 2010 and 2014. Only patients with continuous 12-month insurance coverage after surgery were included. The rates of decompression with arthrodesis versus decompression only and of simple (1- or 2-level, single-approach) versus complex (> 2-level or combined-approach) arthrodesis were analyzed by year and geographic region. These trends were further analyzed with respect to complications, length of hospital stay, payments made to the hospital, and patient discharge status. Statistical significance was set at p < 0.05.RESULTSThe proportion of patients who underwent decompression with arthrodesis compared with decompression only increased significantly and linearly from 2010 to 2014 (OR 1.08; 95% CI 1.06–1.10). Arthrodesis was more likely to be complex rather than simple with each subsequent year (OR 1.4; 95% CI 1.33–1.49). This trend was accompanied by an increased likelihood of postoperative complications (OR 1.11; 95% CI 1.02–1.21), higher costs (payments increased by a mean of US$1633 per year; 95% CI 1327–1939), and greater likelihood of being discharged to a skilled nursing facility as opposed to home (OR 1.11; 95% CI 1.03–1.20). The South and Midwest regions of the US had the highest proportions of patients undergoing arthrodesis (48% and 42%, respectively). The mean length of hospital stay did not change significantly (p = 0.324).CONCLUSIONSFrom 2010 to 2014, the proportion of adults undergoing decompression with arthrodesis versus decompression only for the treatment of LSS increased, especially in the South and Midwest regions of the US. A greater proportion of these fusions were complex and were associated with more complications, higher costs, and a greater likelihood of being discharged to a skilled nursing facility.

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Influence of gender and socioeconomic background on the decision to perform gallstone surgery: a population-based register study

Cited by 18 publications

References 24 publications

Impact of the COVID-19 pandemic on the management of gallstone surgery: A Swedish population-based study

Impact of the COVID-19 pandemic on the management of gallstone surgery: A Swedish population-based study

Cholecystectomy reduces the risk of cholangiocarcinoma in patients with complicated gallstones, but has negligible effect on hepatocellular carcinoma

Trends in isolated lumbar spinal stenosis surgery among working US adults aged 40–64 years, 2010–2014

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