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

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. We describe, at a population level, the management of cholecystitis in Emergency General Surgery in Scotland, UK. Herein, we observe that only 60 per cent of individuals will have an emergency cholecystectomy on index admission. We also describe the risk factors associated with 90-day mortality after admission.

Automated summary

This study aimed to describe the clinical management and outcomes of patients with acute cholecystitis in Scotland, UK. The results showed that 60% of patients had surgery during their initial hospitalization, and the surgical group had a better survival rate compared to the conservative management group, advocating for the use of operative approach in this patient cohort.