Operative Approach Improves Outcomes, Lowers Cost in Multimorbid Older Patients with Acute Cholecystitis

Acker RC, Ginzberg SP, Sharpe J, et al. Operative vs Nonoperative Treatment of Acute Cholecystitis in Older Adults With Multimorbidity. JAMA Surg. 2025.

The authors used data from the Medicare database to compare outcomes of cholecystectomy with nonoperative management for older patients with acute cholecystitis who had multiple comorbid conditions.

Comorbidity burden was calculated using accepted formulas and patients were matched using propensity scoring and instrumental variables. The primary outcomes of interest were 30- and 90-day mortality, rates of emergency department revisits, and rates of readmissions.

Included patients (n = 35,527) had a mean age of 78.8 years; nonoperative management was used in 32.1% of patients. The data showed that, after matching, mortality was equivalent in the two groups. Rates of ED visits and readmissions were significantly lower in the operative group. Costs were higher for operative management during the index hospitalization, but overall costs were lower in the patients managed with cholecystectomy.

The authors concluded that older patients with acute cholecystitis and multiple comorbid conditions who can safely undergo surgery should be managed with cholecystectomy.