Palamuthusingam Dharmenaan, Hawley Carmel M, Pascoe Elaine M, Johnson David Wayne, Sivalingam Palvannan, Wood Simon T, Palamuthusingam Pranavan, Jose Matthew D, Fahim Magid
Metro North Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
J Hepatobiliary Pancreat Sci. 2025 Jun;32(6):465-475. doi: 10.1002/jhbp.12133. Epub 2025 Mar 25.
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.
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.
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).
In patients with acute cholecystitis, compared with nonoperative management, surgery was associated with better survival at 12 months but higher rates of early morbidity.
接受慢性肾脏替代治疗（KRT：透析或肾移植）的肾衰竭患者术后死亡率和发病率增加。本研究评估了接受胆囊切除术的慢性KRT患者与非手术治疗相比急性胆囊炎的治疗结果。
这项双国家人群队列研究使用澳大利亚和新西兰透析与移植（ANZDATA）登记处与2000年至2015年期间各辖区医院入院数据集之间的关联数据，评估了所有接受慢性KRT的新发和现患患者。使用国际疾病分类（ICD）确定原发性急性胆囊炎患者，并将其分为两组：接受胆囊切除术的患者和接受非手术治疗的患者。采用合并症调整的Cox模型确定胆囊切除术与30天和12个月死亡率之间的关联。
在46779例慢性KRT患者中，有1520例最初因急性胆囊炎急诊就诊，其中87%接受了非手术治疗。两组的30天死亡率风险无差异（5.4%对5.1%，p = 0.83）。尽管包括复合心血管并发症（心肌梗死、脑血管意外、心脏骤停：比值比2.08，95%置信区间（1.13 - 3.81））、入住重症监护病房（比值比3.51，95%置信区间（2.41 - 5.10））和输血（比值比2.29，95%置信区间（1.60 - 3.27））等非致命结局的几率更高，但与非手术治疗相比，手术与12个月时生存率提高相关（风险比0.61，95%置信区间（0.43 - 0.87））。接受非手术治疗的患者30天再入院率更高（17.6%对12.5%，p = 0.44）。
在急性胆囊炎患者中，与非手术治疗相比，手术与12个月时更好的生存率相关，但早期发病率更高。
