Factors influencing non-surgical management of acute cholecystitis in Sweden

Abstract Introduction With an aging population, the prevalence of gallstone-related diseases continues to rise, including acute cholecystitis (AC). The Swedish Registry of Gallstone Surgery (GallRiks) records data on AC patients undergoing laparoscopic cholecystectomy. GallRiks does not capture data on conservatively managed patients. This study examines the management of AC in Dalarna County, Sweden, with a focus on non-surgical treatment. Method A retrospective observational study included patients diagnosed with AC in Dalarna County from January to December 2022. Patients were categorised into three groups: Immediate Surgery Group (ISG), Delayed Surgery Group (DSG), and Non-Surgery Group (NSG). Complications and readmissions were monitored one-year post-admission. Demographics and clinical outcomes were compared across groups. Result Of the 452 patients assessed, 316 met the inclusion criteria. The ISG included 228 patients (72.4 %), DSG 35 patients (11.1 %), and NSG 53 patients (16.8 %). NSG patients were significantly older than ISG patients (p < 0.001). Anticoagulant use was more common in DSG and NSG compared to ISG (p < 0.001). Postoperative complications occurred in 74 of 263 surgical patients (28 %), with severe complications (Clavien-Dindo ≥ 3) in 19 of 263 patients (7.1 %). Among the NSG patients, 9 of 53 (17 %) were readmitted for acute cholecystitis within 30 days after initial admission. Discussion Patients with comorbidities or anticoagulant use are more likely to receive non-surgical treatment for acute cholecystitis, this approach however is associated with elevated readmission rates. Strategies to reduce readmissions for this patient group is needed.