Surgical removal of an inflamed gallbladder in the elderly on their first admission for the problem saves both lives and money, according to a new study. Those who did not have the operation, known as a cholecystectomy, on their first admission were 56% more likely to die in the next two years, researchers reported in the May issue of the Journal of the American College of Surgeons, released last week.
Gallstone disease, which is characterized by abdominal pain, nausea, vomiting and fever, is the most costly digestive disease in the United States, with about 20 million people suffering from it. The disease is most common in the elderly and, each year, there are about 1 million hospitalizations and 700,000 cholecystectomies, with a total cost estimated at $5 billion.
Dr. Taylor S. Riall of the University of Texas Southwestern Medical Branch in Galveston and his colleagues used Medicare claims data from 1996 to 2005 to identify 29,818 people who were admitted to hospitals during the period for acute gallbladder inflammation, about 5% of the national total. About 75% of the patients had a cholecystectomy shortly after admission; about 2.1% of those who had the surgery died while in the hospital, compared to 2.7% of those who did not have it. Controlling for other medical conditions, the researchers found that those who did not have the surgery were 56% more likely to die in the two years following discharge from the hospital.
Among those who did not have a cholecystectomy, 38% had a gallstone-related readmission to the hospital within two years, compared to only 4% of those who had surgery. Twenty-seven percent of this group subsequently had a cholecystectomy, generally under emergency conditions. Each such readmission cost an estimated $14,000.
-- Thomas H. Maugh II