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Delaying Gallbladder Removal Ups Complications, Costs

Associated with 38 percent readmission rate within two years in elderly patients

WEDNESDAY, June 9 (HealthDay News) -- Delaying cholecystectomy in elderly adults hospitalized due to acute cholecystitis often results in hospital readmissions within two years and increased patient morbidity, mortality and costs, according to research published in the May issue of the Journal of the American College of Surgeons.

Taylor S. Riall, M.D., of the University of Texas Medical Branch in Galveston, and colleagues used a 5 percent sample of national Medicare claims data from 1996 to 2005 to identify 29,818 patients age 66 and older requiring urgent or emergent hospital admission for acute cholecystitis.

The researchers found that 25 percent of the patients did not undergo cholecystectomy during their index admission. The inpatient mortality rate was higher in those who did not undergo cholecystectomy than those who did undergo the procedure (2.7 versus 2.1 percent). The researchers found a gallstone-related readmission rate of 38 percent in the two years after discharge in those who did not undergo cholecystectomy, compared to a 4 percent rate among those who underwent the procedure. In addition, lack of gallbladder removal was associated with a 27 percent subsequent cholecystectomy rate, and hospital readmission contributed to an additional $7,000 in Medicare payments per readmission.

"Cholecystectomy for acute cholecystitis in elderly patients should be performed during initial hospitalization to prevent recurrent episodes of cholecystitis, multiple readmissions, higher readmission rates, and increased costs," the authors write.

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