The Role of Biological Sex in the Treatment of Acute Cholecystitis

Background Some patients with symptomatic gallstones present with more severe disease, have more difficult anatomy and require more complex operations. While cholecystitis has a female preponderance, some observe a trend towards more challenging disease in male patients. The confluence of gender and patient acuity has not been thoroughly investigated. We hypothesize that males present with worse disease compared to females. Methods The analysis cohort of adults who underwent cholecystectomies was filtered from a five-hospital health system administration registry containing inpatients admitted from Fall 2015 to Fall 2021. The dataset contained demographics, health characteristics, and variables reflecting disease severity and acuity. Univariate analysis and multivariate logistic regression were performed to highlight the relationship between patient variables, including gender, and disease acuity. The data were de-identified prior to analysis and deemed exempt from IRB review. Data were analyzed using R within R-Studio. Results Of 2789 cholecystectomy patients, 1616 (58%) were female and 1173 (42%) were male. Univariate analysis highlighted that males had higher rates of harm (p-value: 0.002), longer inpatient length of stay (p-value: < 0.001), higher hospital cost (p-value: < 0.001), increased laboratory usage (p-value: < 0.001), higher MS-DRG weight (p-value: < 0.001) and greater mortality risk (p-value: < 0.001). Further, multivariate analysis found male cholecystectomy patients were correlated with higher instances of open surgical approach (OR: 1.93; p-value: < 0.001) compared to their female counterparts. Conclusion Males present with worse risk-adjusted gallstone disease and require more hospital resources.