Relapse in gallstone disease after non-operative management of acute cholecystitis: a population-based study

Abstract

Objective: Non-operative management (NOM) of acute cholecystitis (ACC) may be preferable in patients with advanced inflammation, long duration of symptoms or severe comorbidities. This study aims to investigate time to recurrence and patient factors predicting relapse in gallstone complications after NOM.

Methods: Records of 1634 patients treated for ACC at three Swedish centres between 2017 and 2020 were analysed, with 909 managed non-operatively. Data were linked to the National Gallstone Surgery registry for those who later underwent surgery. The time to relapse of gallstone complications was calculated and Cox proportional hazards regression was used to analyse new gallstone complications and adjust for multiple variables.

Results: Of the 909 non-operatively managed patients, 348 patients suffered a new gallstone complication. The median time to recurrence was 82 days. Of those who recurred, 27% did so within 30 days, 17% between 31 and 60 days, 27% between 61 days and 6 months, 16% between 6 months and 1 year and 13% later than 1 year. Younger patients with their first gallstone complication had a lower risk of new complications compared with those with previous gallstone complications. In older individuals, there was no difference in the risk of relapse regardless of previous gallstone complications, but they were more likely to be readmitted than younger patients.

Conclusion: Delayed cholecystectomy should be prioritised for younger patients with a history of gallstone disease if early cholecystectomy is not feasible. Delayed cholecystectomy should be scheduled without a prior outpatient clinic visit to minimise delays.

Keywords: ABDOMINAL PAIN; CHOLECYSTECTOMY; GASTROINTESTINAL SURGERY.

Figure 1. Patient flow chart. All patients with a registered diagnosis of acute cholecystitis (ACC) were screened. Patients not fulfilling the inclusion criteria were excluded, data supplemented by registry data and then separated into a cohort of patients having early surgery (EC) and non-operatively managed (NOM).

Figure 2. Cumulative incidence of gallstone complications after non-operative management in three Swedish hospitals 2017–2020 by age group for patients without (no) and with (yes) previous gallstone complications.