Arkadiusz Peter Wysocki, FRACS, Jennifer Allen, BSc(Hons), Therese Rey-Conde, MPH, John B. North, FRACS
Department of Surgery, Logan Hospital, Meadowbrook, Queensland, Australia (Dr. Wysocki). Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, East Brisbane, Queensland, Australia (Drs. Allen, Rey-Conde, and North).
Background and Objectives: The mortality rate of patients with acute cholecystitis is low with either medical or surgical management. It is unclear how surgeons decide which patients will not undergo cholecystectomy. We postulated those who died following medical management would have a greater burden of comorbidities than those who died following cholecystectomy.
Methods: Adults who died under the care of a surgeon with a diagnosis of acute cholecystitis were identified from the Australian and New Zealand Audit of Surgical Mortality database.
Results: We identified 86 eligible patients, and two-thirds of them were managed medically. Cholecystectomy patients were younger (78 years vs 86 years, P = .028) and had a lower American Society of Anesthesiologists class (3 vs 4, P = .005). Both groups had a similar number of comorbidities (P = .588). Length of stay for the surgical group was 11 days longer than that of the medical group (14 days vs 3 days, P <.001). The frequency of hospital systems issues was the same in both groups.
Conclusions: Patients with acute cholecystitis who died with medical management were older with a higher American Society of Anesthesiologists class than those who died following cholecystectomy. Research is required into the circumstances at time of admission for acute cholecystitis.
Key Words: Mortality, Audit, Acute cholecystitis, Laparoscopy, Cholecystectomy.