Risk of recurrent gallstone complications after non-operative management– a nationwide registry study

Abstract Introduction Non-operative management of gallstone complications (cholangitis, cholecystitis and pancreatitis) leaves patients at risk of recurrent gallstone complications. Previous studies have shown that even patients with severe comorbidity have acceptable risks of complications for early cholecystectomy for cholecystitis. This study aims to investigate the prevalence of non-operative management and what happens if the gallbladder is left in place after cholecystitis, pancreatitis and cholangitis. Method 79,398 patients with gallstone complications between 2006-2019 was identified in the Swedish National Patient Register. Using Cox proportional hazards regression and a competing risk model the hazard ratio for new gallstone complications was calculated. Result Patients with cholangitis were older and more comorbid than those with cholecystitis and pancreatitis. The risk of recurrence was 27-33% at 1 year and 35-40% at 3 years. Patients with cholangitis had a higher risk of recurrence (HR 1.16 95%CI 1.12-1.21) than those with cholecystitis and pancreatitis. Females had a lower risk of recurrence than males (HR 0.93 95%CI 0.91-0.95). Discussion The risk of recurrence in a national material was similar to what was seen in previous studies from other countries. Early cholecystectomy should be considered in patients who can tolerate surgery. Many patients are likely to have recurrences while waiting for delayed surgery.