SP 9.03 MANagement of Gallstone Disease in the Older Patient (MANGO): Results & Quality of Life Outcomes from a Prospective Multicentre Cohort Study
Ana Gavrila, Anna Fairclough, Charlotte Cossins, Simon Toh, Alexander Darbyshire, Amy LordAbstract
Background
Gallstones are a common cause of acute surgical admission in older adults and are often associated with complications. While surgery is recommended in the general population, greater comorbidity makes decision-making more complex in older patients. This study provides prospective evidence on management strategies and quality-of-life (QoL) outcomes in this cohort.
Method
Trainee-led multicentre prospective cohort from nine hospitals in Southwest England. Emergency admissions in patients over 70 with symptomatic gallstone disease from 25/11/2022 to 31/03/2024. Data collected at baseline, 30-day and 1-year.
Results
Of 194 patients, majority received non-operative management (81.4%). They had higher co-morbidities and frailty, with a comparable age to the emergency cholecystectomy group. Thirty-six laparoscopic emergency cholecystectomies were performed, with one conversion to open and no major complications. Median length of stay was similar (7 vs 5 days, p=0.105).
Gallstone-related readmission at 1-year was significantly higher following non-operative management (23.0% vs 2.9%, p=0.024), while non-biliary re-admissions were similar. One-year mortality was 12.4% in the non-operative group and 0% in the operative group. Fourteen patients underwent interval cholecystectomy.
Baseline QoL was similar. At 30 days, emergency cholecystectomy produced better QoL across all GIQLI domains (p≤0.007). At 1 year, QoL remained higher after emergency cholecystectomy (123.8 vs 115.6, p=0.039), but was comparable when interval cholecystectomy patients were included.
Conclusion
Emergency cholecystectomy in older patients deemed suitable for surgery is associated with improved QoL scores and reduced gallstone-related re-admissions at 1-year. Interval surgery also achieved comparable outcomes, and these findings support offering surgery to appropriately selected older patients.