Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1998 Feb;227(2):195–200. doi: 10.1097/00000658-199802000-00007

Symptomatic cholelithiasis: a different disease in men? Connecticut Laparoscopic Cholesystectomy Registry.

J C Russell 1, S J Walsh 1, L Reed-Fourquet 1, A Mattie 1, J Lynch 1
PMCID: PMC1191235  PMID: 9488516

Abstract

OBJECTIVE: To determine the importance of gender in the clinical presentation and subsequent clinical outcome (risk of conversion from laparoscopic to open technique and risk of postoperative mortality) for patients undergoing cholecystectomy. SUMMARY BACKGROUND DATA: Age and clinical presentation have consistently been found to be important predictors of cholecystectomy outcomes; male gender has been cited in disparate studies as possibly having prognostic significance. METHOD: A statewide cholecystectomy registry (30,145 cases between 1989-1993) was analyzed. Hierarchical log-linear modeling was used to identify associations between characteristics of clinical presentation. Multivariate logistic regression analysis was used to determine predictions of conversion and mortality. RESULTS: Male gender was associated with twice the expected incidence of acute cholecystitis and pancreatitis in the elderly (> or = 65 years). Males had a significantly increased risk for conversion to open technique, but this decreased during the time frame of the study. Mortality was twice as high among males (confidence interval, 1.4-2.9, p = 0.0001). CONCLUSIONS: Males presenting for cholecystectomy are more likely to have severe disease. Independent of clinical presentation, they face increased risks of conversion to open technique and of postoperative mortality.

Full text

PDF
196

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Feldman M. G., Russell J. C., Lynch J. T., Mattie A. Comparison of mortality rates for open and closed cholecystectomy in the elderly: Connecticut statewide survey. J Laparoendosc Surg. 1994 Jun;4(3):165–172. doi: 10.1089/lps.1994.4.165. [DOI] [PubMed] [Google Scholar]
  2. Fried G. M., Barkun J. S., Sigman H. H., Joseph L., Clas D., Garzon J., Hinchey E. J., Meakins J. L. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg. 1994 Jan;167(1):35–41. doi: 10.1016/0002-9610(94)90051-5. [DOI] [PubMed] [Google Scholar]
  3. Friedman G. D., Raviola C. A., Fireman B. Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. J Clin Epidemiol. 1989;42(2):127–136. doi: 10.1016/0895-4356(89)90086-3. [DOI] [PubMed] [Google Scholar]
  4. Gagic N., Frey C. F., Gaines R. Acute cholecystitis. Surg Gynecol Obstet. 1975 Jun;140(6):868–874. [PubMed] [Google Scholar]
  5. Glenn F., Dillon L. D. Developing trends in acute cholecystitis and choledocholithiasis. Surg Gynecol Obstet. 1980 Oct;151(4):528–532. [PubMed] [Google Scholar]
  6. HORWITZ A. Gallbladder disease in the aged. J Am Med Assoc. 1956 Jul 21;161(12):1119–1123. doi: 10.1001/jama.1956.02970120001001. [DOI] [PubMed] [Google Scholar]
  7. Ibach J. R., Jr, Hume H. A., Erb W. H. Cholecystectomy in the aged. Surg Gynecol Obstet. 1968 Mar;126(3):523–528. [PubMed] [Google Scholar]
  8. Koo K. P., Thirlby R. C. Laparoscopic cholecystectomy in acute cholecystitis. What is the optimal timing for operation? Arch Surg. 1996 May;131(5):540–545. doi: 10.1001/archsurg.1996.01430170086016. [DOI] [PubMed] [Google Scholar]
  9. MacDonald J. A. Early cholecystectomy for acute cholecystitis. Can Med Assoc J. 1974 Oct 19;111(8):796–799. [PMC free article] [PubMed] [Google Scholar]
  10. Margiotta S. J., Jr, Horwitz J. R., Willis I. H., Wallack M. K. Cholecystectomy in the elderly. Am J Surg. 1988 Dec;156(6):509–512. doi: 10.1016/s0002-9610(88)80541-5. [DOI] [PubMed] [Google Scholar]
  11. Morrow D. J., Thompson J., Wilson S. E. Acute cholecystitis in the elderly: a surgical emergency. Arch Surg. 1978 Oct;113(10):1149–1152. doi: 10.1001/archsurg.1978.01370220035006. [DOI] [PubMed] [Google Scholar]
  12. Orlando R., 3rd, Russell J. C., Lynch J., Mattie A. Laparoscopic cholecystectomy. A statewide experience. The Connecticut Laparoscopic Cholecystectomy Registry. Arch Surg. 1993 May;128(5):494–499. doi: 10.1001/archsurg.1993.01420170024002. [DOI] [PubMed] [Google Scholar]
  13. Rice D. P., Hodgson T. A., Kopstein A. N. The economic costs of illness: a replication and update. Health Care Financ Rev. 1985 Fall;7(1):61–80. [PMC free article] [PubMed] [Google Scholar]
  14. Russell J. C., Walsh S. J., Mattie A. S., Lynch J. T. Bile duct injuries, 1989-1993. A statewide experience. Connecticut Laparoscopic Cholecystectomy Registry. Arch Surg. 1996 Apr;131(4):382–388. doi: 10.1001/archsurg.1996.01430160040007. [DOI] [PubMed] [Google Scholar]
  15. STROHL E. L., DIFFENBAUGH W. G. Biliary tract surgery in the aged patient. Surg Gynecol Obstet. 1953 Oct;97(4):467–470. [PubMed] [Google Scholar]
  16. Sanabria J. R., Gallinger S., Croxford R., Strasberg S. M. Risk factors in elective laparoscopic cholecystectomy for conversion to open cholecystectomy. J Am Coll Surg. 1994 Dec;179(6):696–704. [PubMed] [Google Scholar]
  17. Steiger E., Seltzer M. H., Rosato F. E. Cholecystectomy in the aged. Ann Surg. 1971 Jul;174(1):142–144. doi: 10.1097/00000658-197107010-00023. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. WRIGHT H. K., HOLDEN W. D., CLARK J. H. Age as a factor in the mortality rate for biliary-tract operations. J Am Geriatr Soc. 1963 May;11:422–425. doi: 10.1111/j.1532-5415.1963.tb00538.x. [DOI] [PubMed] [Google Scholar]
  19. Wetter L. A., Way L. W. Surgical therapy for gallstone disease. Gastroenterol Clin North Am. 1991 Mar;20(1):157–169. [PubMed] [Google Scholar]
  20. Wilson A. K., Kozol R. A., Salwen W. A., Manov L. J., Tennenberg S. D. Gangrenous cholecystitis in an urban VA hospital. J Surg Res. 1994 May;56(5):402–404. doi: 10.1006/jsre.1994.1064. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES