Recurrence and mortality after non-operative management of acute gallstone disease: nationwide registry study

Why clinicians should know about it

• Picked for Surgery (paper of the day, 8 November 2026): Nationwide outcomes quantify recurrence after non-operative gallstone management

Abstract

BACKGROUND: Non-operative management of gallstone complications (acute cholecystitis, cholangitis, and biliary pancreatitis) carries a significant risk of recurrence. Nevertheless, definitive surgery is often deferred in co-morbid patients due to their perceived short life expectancy. This study assessed the prevalence of non-operative management, and its associated mortality and recurrence risk, accounting for the competing risk of death due to other causes. METHODS: A nationwide cohort of patients admitted with gallstone complications and treated with non-operative management between 2006 and 2019 was identified in the Swedish National Patient Register. Competing risk and Cox proportional hazards models were used to evaluate recurrence and mortality risks. RESULTS: Overall, 82 101 patients were included (median age 68 years, 48% female), of whom 41 283 (50.3%) experienced cholecystitis, 10 272 (12.5%) experienced cholangitis, and 30 546 (37.2%) experienced pancreatitis. Patients with cholangitis were older and had more co-morbidities than those with cholecystitis or pancreatitis. The cumulative recurrence risk at 1 year was 16.0% for cholecystitis, cholangitis, and pancreatitis. At 3 years, the risk was 19.8% for cholecystitis and 23.0% for cholangitis and 22.5% for pancreatitis. In patients aged ≥ 80 years, 3-year mortality was 41.2%, and 17.0% of deaths were gallstone related. In competing risk analyses, cholangitis and pancreatitis were associated with a higher recurrence risk than cholecystitis in alive patients, with hazard ratio (HRs) of 1.22 (95% confidence interval (c.i.) 1.16 to 1.28) and 1.28 (95% c.i. 1.24 to 1.32), respectively, whereas female sex was associated with a lower recurrence risk (HR 0.92; 95% c.i. 0.89 to 0.94). Increasing age (HR 1.08; 95% c.i. 1.08 to 1.09), co-morbidities (HR 1.17; 95% c.i. 1.16 to 1.17), and cholangitis (HR 1.31; 95% c.i. 1.26 to 1.36) were associated with an increased risk of mortality. CONCLUSION: The risk of recurrent gallstone complications remains clinically important, even among older and co-morbid patients, despite their higher competing risk of death. These findings support consideration of early cholecystectomy in patients with an acceptable operative risk, with the aim of reducing subsequent morbidity and recurrence.

Abstract as published, via PubMed.