Operative and nonoperative management of acute cholecystitis in patients on chronic kidney replacement therapy.

BACKGROUND

Patients with kidney failure receiving chronic kidney replacement therapy (KRT: dialysis or kidney transplantation) have increased risks of postoperative mortality and morbidity. This study assesses the outcomes of acute cholecystitis in patients on chronic KRT who undergo cholecystectomy compared to nonoperative management.

METHODS

This bi-national population cohort study evaluated all incident and prevalent patients receiving chronic KRT using linked data between Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admission datasets between 2000 and 2015. Patients with a primary diagnosis of acute cholecystitis were identified using the International Classification of Diseases (ICD) and were divided into two groups: patients who underwent cholecystectomy and those who received nonoperative management. Comorbidity-adjusted Cox models were used to determine the associations of cholecystectomy with 30-day and 12-month mortality.

RESULTS

From the 46 779 patients on chronic KRT, there were 1520 patients with an initial emergency presentation of acute cholecystitis, of whom 87% received nonoperative management. Thirty-day mortality risk was no different between the two groups (5.4 vs. 5.1%, p = .83). Despite higher odds for nonfatal outcomes including composite cardiovascular complications (MI, CVA, cardiac arrest: OR 2.08, 95% CI (1.13-3.81)), ICU admission (OR 3.51, 95% CI (2.41-5.10)), and blood transfusions (OR 2.29, 95% CI (1.60-3.27)), surgery was associated with improved survival at 12 months compared with nonoperative management (HR 0.61, 95% CI (0.43-0.87)). Patients who received nonoperative management had a higher 30-day readmission rate (17.6 vs. 12.5%, p = .44).

CONCLUSIONS

In patients with acute cholecystitis, compared with nonoperative management, surgery was associated with better survival at 12 months but higher rates of early morbidity.