Gender Differences in Choice of Procedure and Case Fatality Rate for Elderly Patients with Acute Cholecystitis: A Masters Thesis
Authors
Collins, Courtney E.Faculty Advisor
Heena Santry, MD, MSAcademic Program
Master of Science in Clinical InvestigationUMass Chan Affiliations
SurgeryDocument Type
Master's ThesisPublication Date
2015-12-02Keywords
Theses, UMMSAged
Cholecystectomy
Cholecystitis
Cholecystitis, Acute
Cholecystostomy
Treatment Outcome
Aged
Cholecystectomy
Cholecystitis
Acute Cholecystitis
Cholecystostomy
Treatment Outcome
Digestive System Diseases
Gastroenterology
Geriatrics
Health Services Administration
Surgical Procedures, Operative
Metadata
Show full item recordAbstract
Background: Treatment decisions for elderly patients with gallbladder pathology are complex. Little is known about what factors go into treatment decisions in this population. We used Medicare data to examine gender-based differences in the use of cholecystectomy vs. cholecystostomy tube placement in elderly patients with acute cholecystitis. Methods: We queried a 5% random sample of Medicare data (2009-2011) for patients >65 admitted for acute cholecystitis (by ICD-9 code) who subsequently underwent a cholecystectomy and/or cholecystostomy tube placement. Demographic information (age, race), clinical characteristics (Elixhauser index, presence of biliary pathology), and hospital outcomes (case fatality rate, length of stay, need for ICU care) were compared by gender. A multivariable model was used to examine predictors of cholecystectomy vs. cholecystostomy tube placement. Results: Of 4063 patients admitted with cholecystitis undergoing the procedures of interest just over half (58%) were women. The majority of patients (93%) underwent cholecystectomy. Compared to women, men were younger (average age 76 vs. 78, p value < 0.01) and had few comorbidities (average Elixhauser 1.2 vs. 1.4 p value < 0.01). Case fatality rate was similar between men (2.5%) and women (2.4% p value 0.48). A higher percentage of men spent time in the ICU (36%) compared to women (31% p value < 0.01). On multivariable analysis men were 30% less likely to undergo cholecystectomy (OR 0.69, 95% CI 0.53-0.91). Conclusion: Elderly men are less likely than elderly women to undergo cholecystectomy for acute cholecystitis despite being younger with less co morbidity and are more likely to spend time in the ICU. More research is needed to determine whether a difference in treatment is contributing to the higher rate of ICU utilization in elderly men with acute cholecystitis.DOI
10.13028/M2830NPermanent Link to this Item
http://hdl.handle.net/20.500.14038/32175Rights
Copyright is held by the author, with all rights reserved.ae974a485f413a2113503eed53cd6c53
10.13028/M2830N
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