Cholecystitis Treatment and Outcomes Among People Living With Dementia.

Background: Cholecystectomy is considered the definitive treatment option for cholecystitis, but the effect of different treatment options among people living with dementia (PLWD) has not been elucidated. This study compares outcomes following cholecystectomy, cholecystostomy tube, and medical management of cholecystitis among this high-risk group.

Methods: We conducted a retrospective analysis of Medicare claims data 1/1/2016 to 12/31/2020. The cohort comprised Medicare PLWD aged 66+ admitted to acute care facilities with a new primary diagnosis of cholecystitis. We used inverse propensity weighting regression to adjust for confounding by indication. We compared outcomes during index admission, readmissions, and mortality.

Results: Eight thousand and seven hundred and seventy four individuals met inclusion criteria; 7% open cholecystectomy, 49% minimally invasive (MIS) cholecystectomy, 13% cholecystostomy tube, 31% managed medically. After adjustment, PLWD undergoing open or MIS cholecystectomy had a greater risk of intensive interventions (Open OR 3.3, p < 0.001; MIS OR 1.3, p = 0.02) and surgical complications (Open OR 10.6, p < 0.001; MIS OR 3.3, p < 0.001) during the index admission, but a lower risk of readmission (Open HR 0.9, p = 0.009; MIS HR 0.9, p < 0.001) and lower mortality (Open HR 0.6, p < 0.001; MIS 0.6, p < 0.001) compared with PLWD managed medically. PLWD managed with cholecystostomy tube had no difference in intensive interventions or surgical complications during the index admission, but a higher risk of readmission (HR 1.1, p = 0.01), cholecystectomy during readmission (HR 1.8, p < 0.001) and no difference in mortality compared to those managed medically.

Conclusions: Over half of PLWD experiencing acute cholecystitis received definitive surgical treatment during the index admission. Open and MIS cholecystectomy were associated with worse outcomes during the index admission, but reduced mortality and readmissions in the 2 years following index admission. Cholecystostomy tube was associated with a greater likelihood of readmission and subsequent cholecystectomy, and no difference in mortality. These findings should be interpreted within the context of administrative data, which has the potential for selection bias and unmeasured confounding.