Surgery Improves Long-Term Survival in Kidney Failure Patients with Acute Cholecystitis: Study
Researchers have identified in a new study that patients with renal failure undergoing chronic kidney replacement therapy (KRT), such as dialysis or kidney transplantation, are at high risk of postoperative complications. The results indicate that while surgery is at increased risk of early complications, it is linked with better survival at 12 months. The study was conducted by Dharmenaan and colleagues published in the Journal of Hepato-Biliary-Pancreatic Sciences.
A bi-national population cohort study was done with the assistance of Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data and jurisdictional hospital admission data. All incident and prevalent patients receiving chronic KRT between 2000 and 2015 were included in the study. Those patients diagnosed with acute cholecystitis were identified by using the International Classification of Diseases (ICD) and divided into two groups based on whether or not they underwent cholecystectomy and how they were managed nonoperatively. Comorbidity-adjusted Cox models were used to examine 30-day and 12-month mortality between groups.
Key Findings
• Of 46,779 patients receiving chronic KRT, 1,520 presented initially with acute cholecystitis in emergency.
• Nonoperative management was provided to 87% of patients, while the rest were subjected to cholecystectomy.
• 30-day mortality rates between the surgery and nonoperative groups were comparable (5.4% vs. 5.1%, p =0.83).
Surgery was linked to higher risks of nonfatal complications, such as:
• Cardiovascular complications (OR 2.08, 95% CI 1.13–3.81)
• ICU admission (OR 3.51, 95% CI 2.41–5.10)
• Blood transfusions (OR 2.29, 95% CI 1.60–3.27)
• 12-month survival was increased significantly in the surgery group (HR 0.61, 95% CI 0.43–0.87) compared to nonoperatively treated patients.
• Increased 30-day readmission was observed in the nonoperative group (17.6% vs. 12.5%, p = 0.44).
The study authors concluded that patients with kidney failure undergoing chronic KRT who undergo an operation for acute cholecystitis have better 12-month survival rates when compared to nonoperative management patients. These observations point toward the necessity of individualized treatment protocols and vigilant monitoring to maximize patient benefit.
Reference:
Palamuthusingam, D., Hawley, C. M., Pascoe, E. M., Johnson, D. W., Sivalingam, P., Wood, S. T., Palamuthusingam, P., Jose, M. D., & Fahim, M. (2025). Operative and nonoperative management of acute cholecystitis in patients on chronic kidney replacement therapy. Journal of Hepato-Biliary-Pancreatic Sciences. https://doi.org/10.1002/jhbp.12133
