Frailty, Critical Illness and Non-Operative Management Predict Worse Outcome in Cholecystitis in a High Risk Population

Author(s):
Robyn Marks; Claudia Ramjattan; Melissa Harry; Kristin Colling

Background:

Cholecystitis is a common reason for admission in the United States. Studies evaluating complex operations such as colectomy, have reported worse outcomes associated with an individual’s socioeconomic advance, and we wanted to evaluate factors associated with outcomes in cholecystitis, the most common general surgical procedure performed in the US, in a high risk, rural population with a high prevalence of socioeconomic hardship.

Hypothesis:

We hypothesized that socioeconomic disadvantage will be associated with worse outcomes in cholecystitis.

Methods:

We performed a retrospective review of patients admitted with cholecystitis between 1/2018 and 12/2022 to a single tertiary hospital. Patient demographics, Charlson Comorbidity Index (CCI), and hospital data were collected for all patients. Area deprivation index was used to quantify an individual’s socioeconomic disadvantage (higher deciles equate to greater disadvantage).

Results:

691 patients with cholecystitis were included in the study. The cohort was old (median age 66) and 48% were from areas in the highest quartile ADI. Median ADI was in the 7th decile (higher is higher risk) and the Interquartile range (IQR) was 5-9. Hospital mortality was 1%, 30 day post-discharge mortality rate was 3% and 30 day readmission rate was 14%. 114 patients (16%) did not have a cholecystectomy during the index admission. Patients managed non-operatively had higher median CCI (2 (IQR 0-5) versus 0 (IQR 0-2) p<0.001) and were more likely to have an ICU admission (11% versus 6%, p<0.001). ADI was not associated with cholecystitis management. Cholecystectomy was associated with lower hospital mortality and readmissions (Figure). In addition to nonoperative management,  markers of critical illness (ICU admission, longer hospital stay, elevated white blood cell count) and factors associated with frailty (low albumin, higher CCI) were associated with higher odds of readmission and mortality. No SDOHs were associated with outcome.

Conclusions:

In a cohort of patients with cholecystitis that is notable for its elderly population with half the cohort from highest quartile ADIs, we found that non-operative management and factors associated with critical illness and frailty were associated with worse outcomes. In this high risk group, ADI was not associated with outcome.