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Determinants for symptomatic gallstone disease readmissions - results from a cohort with screen-detected gallstone disease

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@article{9416051358f5490a828f3c536c18ea7a,
title = "Determinants for symptomatic gallstone disease readmissions - results from a cohort with screen-detected gallstone disease",
abstract = "AIM OF THE STUDY: Selection of patients for cholecystectomy is hampered by lack of objective criteria. The objectives of this cohort study were to identify if patient, symptoms, or gallstone disease characteristics determined readmission in an unselected cohort with screen-detected gallstone disease and who had experienced a first admission with symptomatic gallstone disease.METHODS: Data from three random sampled population-based cohorts were used. At baseline, participants were screened with ultrasound and 664 had gallstones of which 84 had a first admission without cholecystectomy performed. A cohort study was performed with follow-up up for hospital readmissions beyond 30 days through central registers. Age adjusted Cox regression analyses were performed.RESULTS: Readmissions occurred in 60.8{\%} and cholecystectomy was eventually performed in 47.7{\%} of patients. Early readmissions were determined by abdominal pain in the epigastrium (Hazard ratio (HR) 3.63, 95{\%} confidence interval (CI) [1.62;8.12]) and of moderate intensity (HR 2.71, 95{\%} CI [1.20;6.16]). Late readmissions were determined by larger gallstone size, especially when above 10mm (HR 4.11, 95{\%} CI [1.18;14.3]) and inversely determined by age (HR 0.97, 95{\%} CI [0.95;0.998]). In patients with initially uncomplicated gallstone disease, cholecystectomy was inversely determined by age (HR 0.96, 95{\%} CI [0.93;0.98]).CONCLUSION: Once gallstones have become symptomatic and caused hospital admission, a persisting high risk for future readmission exists and half of patients end up having cholecystectomy. Pain in the epigastrium, larger gallstones, and younger age determine readmission. These determinants should be tested in future clinical treatment algorithms for gallstone disease.",
keywords = "Cholecystolithiasis, Cholelithiasis, Gallbladder diseases, Ultrasonography",
author = "Shabanzadeh, {D M} and S{\o}rensen, {L T} and T J{\o}rgensen",
note = "Copyright {\circledC} 2019 Elsevier Masson SAS. All rights reserved.",
year = "2019",
month = "10",
doi = "10.1016/j.jviscsurg.2019.02.005",
language = "English",
volume = "156",
pages = "387--396",
journal = "Journal of visceral surgery",
issn = "1878-7886",
publisher = "Elsevier Masson",
number = "5",

}

RIS

TY - JOUR

T1 - Determinants for symptomatic gallstone disease readmissions - results from a cohort with screen-detected gallstone disease

AU - Shabanzadeh, D M

AU - Sørensen, L T

AU - Jørgensen, T

N1 - Copyright © 2019 Elsevier Masson SAS. All rights reserved.

PY - 2019/10

Y1 - 2019/10

N2 - AIM OF THE STUDY: Selection of patients for cholecystectomy is hampered by lack of objective criteria. The objectives of this cohort study were to identify if patient, symptoms, or gallstone disease characteristics determined readmission in an unselected cohort with screen-detected gallstone disease and who had experienced a first admission with symptomatic gallstone disease.METHODS: Data from three random sampled population-based cohorts were used. At baseline, participants were screened with ultrasound and 664 had gallstones of which 84 had a first admission without cholecystectomy performed. A cohort study was performed with follow-up up for hospital readmissions beyond 30 days through central registers. Age adjusted Cox regression analyses were performed.RESULTS: Readmissions occurred in 60.8% and cholecystectomy was eventually performed in 47.7% of patients. Early readmissions were determined by abdominal pain in the epigastrium (Hazard ratio (HR) 3.63, 95% confidence interval (CI) [1.62;8.12]) and of moderate intensity (HR 2.71, 95% CI [1.20;6.16]). Late readmissions were determined by larger gallstone size, especially when above 10mm (HR 4.11, 95% CI [1.18;14.3]) and inversely determined by age (HR 0.97, 95% CI [0.95;0.998]). In patients with initially uncomplicated gallstone disease, cholecystectomy was inversely determined by age (HR 0.96, 95% CI [0.93;0.98]).CONCLUSION: Once gallstones have become symptomatic and caused hospital admission, a persisting high risk for future readmission exists and half of patients end up having cholecystectomy. Pain in the epigastrium, larger gallstones, and younger age determine readmission. These determinants should be tested in future clinical treatment algorithms for gallstone disease.

AB - AIM OF THE STUDY: Selection of patients for cholecystectomy is hampered by lack of objective criteria. The objectives of this cohort study were to identify if patient, symptoms, or gallstone disease characteristics determined readmission in an unselected cohort with screen-detected gallstone disease and who had experienced a first admission with symptomatic gallstone disease.METHODS: Data from three random sampled population-based cohorts were used. At baseline, participants were screened with ultrasound and 664 had gallstones of which 84 had a first admission without cholecystectomy performed. A cohort study was performed with follow-up up for hospital readmissions beyond 30 days through central registers. Age adjusted Cox regression analyses were performed.RESULTS: Readmissions occurred in 60.8% and cholecystectomy was eventually performed in 47.7% of patients. Early readmissions were determined by abdominal pain in the epigastrium (Hazard ratio (HR) 3.63, 95% confidence interval (CI) [1.62;8.12]) and of moderate intensity (HR 2.71, 95% CI [1.20;6.16]). Late readmissions were determined by larger gallstone size, especially when above 10mm (HR 4.11, 95% CI [1.18;14.3]) and inversely determined by age (HR 0.97, 95% CI [0.95;0.998]). In patients with initially uncomplicated gallstone disease, cholecystectomy was inversely determined by age (HR 0.96, 95% CI [0.93;0.98]).CONCLUSION: Once gallstones have become symptomatic and caused hospital admission, a persisting high risk for future readmission exists and half of patients end up having cholecystectomy. Pain in the epigastrium, larger gallstones, and younger age determine readmission. These determinants should be tested in future clinical treatment algorithms for gallstone disease.

KW - Cholecystolithiasis

KW - Cholelithiasis

KW - Gallbladder diseases

KW - Ultrasonography

UR - http://www.scopus.com/inward/record.url?scp=85062037720&partnerID=8YFLogxK

U2 - 10.1016/j.jviscsurg.2019.02.005

DO - 10.1016/j.jviscsurg.2019.02.005

M3 - Journal article

VL - 156

SP - 387

EP - 396

JO - Journal of visceral surgery

JF - Journal of visceral surgery

SN - 1878-7886

IS - 5

ER -

ID: 56741356