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

Mohamed Bekheit; Sendhil Rajan; Jared M Wohlgemut; Angus J M Watson; George Ramsay

doi:10.1093/bjsopen/zrad073

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

Mohamed Bekheit, Sendhil Rajan, Jared M Wohlgemut, Angus J M Watson, George Ramsay

Health Services Research Unit (HSRU)

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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.

Original language	English
Article number	zrad073
Journal	BJS Open
Volume	7
Issue number	4
Early online date	3 Jul 2023
DOIs	https://doi.org/10.1093/bjsopen/zrad073
Publication status	Published - 14 Aug 2023

Bibliographical note

Funding
The study was funded by an NHS Grampian endowment fund (NER 11062).

© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

Elements of this paper were presented as an oral presentation at the Surgical Research Society in Nottingham, UK on 25 March 2023. Data from this paper have also been presented in the Moynihan prize presentation section of the Association of Surgeons of Great Britain and Ireland, Harrogate, UK on 18 May 2023

Data Availability Statement

These data were provided to us through Information Services Division Scotland of NHS Scotland after approvals were obtained. They were analysed in the NHS Scotland Data Safehaven. As such, they are not available to be provided by the authors but are available through ISD Scotland.

Keywords

Adult
Humans
Female
Middle Aged
Male
Cohort Studies
Cholecystitis, Acute/diagnosis
Cholecystectomy
Hospitalization
Scotland/epidemiology

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Bekheit_etal_BJSO_Comprehensive_Assessment_Of_VOR
© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Final published version, 270 KBLicence: CC BY

Cite this

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title = "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.",

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author = "Mohamed Bekheit and Sendhil Rajan and Wohlgemut, {Jared M} and Watson, {Angus J M} and George Ramsay",

note = "Funding The study was funded by an NHS Grampian endowment fund (NER 11062). {\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. Elements of this paper were presented as an oral presentation at the Surgical Research Society in Nottingham, UK on 25 March 2023. Data from this paper have also been presented in the Moynihan prize presentation section of the Association of Surgeons of Great Britain and Ireland, Harrogate, UK on 18 May 2023",

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language = "English",

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AU - Bekheit, Mohamed

AU - Rajan, Sendhil

AU - Wohlgemut, Jared M

AU - Watson, Angus J M

AU - Ramsay, George

N1 - Funding The study was funded by an NHS Grampian endowment fund (NER 11062). © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. Elements of this paper were presented as an oral presentation at the Surgical Research Society in Nottingham, UK on 25 March 2023. Data from this paper have also been presented in the Moynihan prize presentation section of the Association of Surgeons of Great Britain and Ireland, Harrogate, UK on 18 May 2023

PY - 2023/8/14

Y1 - 2023/8/14

N2 - 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.

AB - 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.

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KW - Middle Aged

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KW - Cholecystectomy

KW - Hospitalization

KW - Scotland/epidemiology

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DO - 10.1093/bjsopen/zrad073

M3 - Article

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SN - 2474-9842

VL - 7

JO - BJS Open

JF - BJS Open

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M1 - zrad073

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

Abstract

Bibliographical note

Data Availability Statement

Keywords

Access to Document

Other files and links

Fingerprint

Grampian Data Safe Haven (DaSH)

Cite this

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

Abstract

Bibliographical note

Data Availability Statement

Keywords

Access to Document

Other files and links

Fingerprint

Equipment

Grampian Data Safe Haven (DaSH)

Cite this