Gallbladders: To remove them or not to remove them?

Chuck Bednar for redOrbit.com – Your Universe Online

Even though it’s one of the most common procedures performed on older adults, the majority of those that would benefit the most from gallbladder removal are not having the surgery, according to new research from the University of Texas Medical Branch at Galveston.

UTMB researchers had previously reported that a combination of factors including age, sex, race and severity of gallbladder symptoms could elevate a person’s risk of experiencing an acute attack of the bile-storing organ. The study led to the development of a predictive model that could determine which patients were in the most danger and would benefit most from gallbladder removal.

They then put that model to the test in a new study, reviewing the records of over 160,000 Texas Medicare patients at least 66 years of age who experienced an initial episode of gallstone trouble within an 11-year period. Next, they used their predictive model to determine which of those patients would be most likely to experience a dangerous gallbladder attack over the next two years.

While the patients in the highest-risk category should be the ones undergoing the procedure most frequently, the UTMB researchers found that the opposite was true. Those in facing the highest risk of gallbladder issues had them removed the least often, according to the study, which will be published in the January edition of the Journal of the American College of Surgeons.

Despite recommendations, “less than a quarter of patients in this study had their gallbladders removed. We sought to determine whether the decision to have the gallbladder removed was actually based on their risk of having gallstone-related complications in the next two years,” said lead author and UTMB professor of surgery Dr. Taylor Riall.

Dr. Riall and her colleagues used their model to indentify which patients were at low, moderate or high-risk for an acute gallbladder episode that required hospitalization. Among those who did not have their gallbladder removed, less than 20 percent in the low-risk group wind up being hospitalized for gallbladder-related issues within two years, compared to 65 percent for the high-risk group.

The authors also looked at patients who had the surgery and found that risk was not linked to the removal of the gallbladder. Just 22 percent of people in the low-risk group, 21 percent in the moderate-risk group, and 23 percent in the high-risk group had their gallbladder removed, they said. In the healthiest older patients, gallbladder removal was performed in 34 percent of low-risk patients but in only 27 percent of the highest-risk patients, and less than 10 percent who did not undergo the procedure even consulted a surgeon after the initial episode.

According to the researchers, the risk of developing gallstones increases with age. An individual under the age of 40 has just an 8 percent chance of developing gallstones, but the risk spikes to over 50 percent in people 70 years and older. Gallbladder disease is the most common cause of acute abdominal pain in older patients, and removal of the organ accounts for roughly one-third of all abdominal operations in patients over the age of 65.

“The UTMB risk prediction model provides a starting point for individualized care and shared decision making in older patients with gallstones,” the university said. “Integrating this model into clinical practice, especially at the level of the primary care physician, may improve outcomes by increasing elective gallbladder removal rates in the patients at highest risk and prevent future complications in this vulnerable population.”

“This information would also allow physicians to avoid gallbladder removal in patients who are a high surgical risk and at low risk for developing complications from their gallstones,” it added. “In patients with lower risk and the decision for gallbladder removal is based on preference, this information can help patients make decisions in the context of their symptoms and the impact on their quality of life.”

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