OPERATIVE AND NON-OPERATIVE MANAGEMENT OF ACUTE CHOLECYSTITIS IN PATIENTS ON CHRONIC KIDNEY REPLACEMENT THERAPY
Dr Dharmenaan Palamuthusingam1, Professor Carmel M Hawley2, Ms Elaine M Pascoe3, Professor David W Johnson2, A/Prof. Palvannan Sivalingam2, Dr Simon T Wood2, Dr Pranavan Palamuthusingam1, Professor Matthew D Jose5, Dr Magid Fahim4
1Royal Brisbane And Womens Hospital, , Australia, 2Princess Alexandra Hospital, , Australia, 3University of Queensland, , Australia, 4Digital Metro North, , Australia, 5Royal Hobart Hospital, , Australia
This study assessed the outcomes of acute cholecystitis in patients on chronic kidney replacment therapy (KRT) who undergo cholecystectomy compared to nonoperative management.
This bi-national population cohort study evaluated all incident and prevalent patients receiving chronic KRT using linked data between Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admission datasets between 2000 and 2015. Patients with a primary diagnosis of acute choelcystitis were idenitifed using the International Classification of Diseases – 10 Australian Modification (ICD-10AM) Patients were divided into two groups: patients who underwent cholecsytectomy and those who recevied non-operative management. Comorbidity-adjusted Cox models were used to determine the associations of cholecystectomy with 30-day and 12-month mortality. Secondary non-fatal outcomes were compared using logistic regression.
From the 46,779 patients on chronic KRT who were linked between the datasets, there were 1520 patients with an initial emergency presentation of acute cholecystitis, of whom 87% received non-operative management. Thirty-day mortality risk was no different between the two groups (5.4 vs. 5.1%, p=0.83). Despite higher odds for non-fatal outcomes including composite cardiovascular complications (MI, CVA, cardiac arrest: OR 2.08, 95%CI (1.13-3.81)), ICU admission (OR3.51, 95%CI (2.41-5.10)), and blood transfusions (OR 2.29, 95%CI (1.60-3.27), surgery was associated with improved survival at 12-months compared with non-operative management (HR 0.61, 95%CI 0.43-0.87). These findings were also observed in patients on chronic dialysis only (HR 0.68, 95%CI 0.46-0.98), but not in kidney transplant recipients. Patients who received non-operative management had a higher 30-day readmission rate (17.6 vs. 12.5%, p=0.44).
In patients on chronic KRT with acute cholecystitis, compared with non-operative management, surgery is associated with better survival at 12 months but higher rates of early morbidity.
Biography:
Dr. Dharmenaan Palamuthusingam is a consultant nephrologist at the Royal Brisbane and Womens Hospital