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Management of Acute Cholecystitis in a National Sample of Medicare Beneficiaries
*Courtney Collins, *Julie M Flahive, *Fred A Anderson, Jr, *Heena P Santry
University of Massachusetts, Worcester, MA
Objective:
To determine predictors of cholecystectomy, cholecystostomy tube, and non-operative management among elderly patients admitted with acute cholecystitis Design:
Retrospective review of a 5% random sample Medicare claims data(2009-2011)
Setting:
US acute care hospitals accepting Medicare patients
Patients:
Patients ≥65 admitted emergently/urgently with a primary diagnosis of acute cholecystitis.
Interventions:
Main Outcome Measures:
Utilization of cholecystectomy, cholecystostomy, and in hospital mortality was compared by sociodemographic(age, race, gender) and clinical(Elixhauser index, co-occurring biliary pathology) characteristics using univariate tests of association .Regression models were used to predict cholecystectomy(polytomous model) and mortality (logistic model).
Results:
Of 5521 patients admitted with acute cholecystitis, 69% underwent cholecystectomy,4.7% underwent only cholecystostomy tube, and 26% were managed non-operatively. In univariate analyses, men, blacks, older patients, and patients with cholangitis or higher comorbidities were less likely to undergo cholecystectomy(Table 1). In multivariable analyses only male sex, increasing age, more comorbidities, and co-occurrence of cholangitis were predictive of non-operative management(Table 2). Non-operative management more than than tripled the odds of mortality(OR 3.15,95%CI 2.3-4.4)
Conclusions:
Men and the “oldest old” are less likely to undergo operative management for acute cholecystitis, placing them at high risk of mortality. While there may be opportunity to modify factors that preclude surgery, older patients with acute cholecystitis should be counseled that this is a high risk disease.
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