Cholecystectomy Before 40 May Raise Mortality Risk, Suggests Swedish Study

The findings were published in Clinical Gastroenterology and Hepatology and led by Dr. Louise Emilsson from Vårdcentralen Värmlands Nysäter and the Centre for Clinical Research, Värmland.

"We found that undergoing cholecystectomy at a younger age was linked to higher long-term mortality, likely influenced by factors such as alcohol use and smoking," the researchers wrote. "In contrast, individuals over 50 showed a slightly lower mortality risk, possibly due to better overall health among those selected for surgery."

The nationwide cohort study analyzed data from 159,946 adults aged 20 to 79 years who had undergone a first-time cholecystectomy between 1969 and 2016. Each patient was matched with five individuals from the general population, resulting in a comparison group of 764,681 individuals with no history of gallbladder removal or disease.

Researchers followed participants for a median of 12 years, linking pathology reports with national health and mortality registers to assess long-term outcomes.

The key findings of the study were as follows:

• A total of 38,401 deaths were recorded in the cholecystectomy group, compared to 181,197 deaths in the general population group.
• Mortality rates were similar between the two groups, at 18.5 versus 18.4 deaths per 1,000 person-years.
• Adjusted analysis showed a slightly lower overall mortality risk after cholecystectomy, with an adjusted hazard ratio (aHR) of 0.91.
• The surgery was associated with reduced cardiovascular mortality.
• Individuals aged 20–39 years who underwent cholecystectomy had a 42% higher risk of death (aHR: 1.42) compared to their counterparts in the general population.
• Those aged 40–49 had a modest but statistically significant increase in mortality risk (aHR: 1.07).
• Among younger patients who died, 12.2% had alcohol-related diseases, and 7.4% had smoking-related disorders.
• Patients aged over 50 years at the time of surgery experienced a slightly lower risk of death than the general population.
• Researchers suggested that this reduced risk in older individuals may reflect better underlying health in patients selected for surgery.
• No significant association was observed between cholecystectomy and cancer-related mortality (aHR: 1.01).

“Our results indicate a need for further research into the causes of higher mortality in younger adults after cholecystectomy,” the authors stated. “Targeted interventions addressing modifiable risk factors like obesity, alcohol use, and smoking may help reduce excess mortality in this population.”

These findings offer a deeper understanding of the long-term outcomes following cholecystectomy and highlight the importance of individualized post-operative care, particularly in younger patients with lifestyle-related risks.

Reference:

Emilsson, L., Joshi, A. D., & Ludvigsson, J. F. (2025). Long-term mortality after cholecystectomy in a nationwide cohort of Swedish individuals between 1969 and 2016. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2025.04.015