Sex differences and outcomes of management of acute cholecystitis.

BACKGROUND

Several series have reported differences in characteristics, severity, operative complexity, and outcomes of patients with symptomatic gallstone disease according to sex. Whether sex truly influences outcomes of patients with acute cholecystitis in the current era of early laparoscopic cholecystectomy for acute cholecystitis is unknown.

METHODS

Patients with histologically confirmed acute cholecystitis treated by a specialized unit in a tertiary hospital between November 2005 and January 2011 were identified. Retrospective review of data was undertaken and patients were compared according to sex.

RESULTS

There were 386 cases of confirmed acute cholecystitis in this series, with 181 (47%) occurring in male patients. Male patients with acute cholecystitis tended to be older (66 vs. 57 y; P < 0.001) and were more likely to have underlying diabetes (21% vs. 9%; P = 0.001), ischemic heart disease (24% vs. 8%; P < 0.001), chronic liver disease (6% vs. 1%; P = 0.015), and chronic obstructive airways disease (11% vs. 5%; P = 0.025). They were also more likely to be febrile, tachycardic, hypotensive, and exhibit right upper quadrant rigidity at presentation than females (P < 0.05), despite similar duration of symptoms before presentation (P = 0.970). The operative technique, operative time, and rate of conversion to open surgery were similar between the sexes. Gangrenous pathology was, however, more common in male patients (45% vs. 23%; P < 0.001). The overall complication, mortality, and readmission rates were similar between the 2 groups. Males, however, had a longer postoperative length of stay (4 vs. 3 d; P = 0.001).

CONCLUSIONS

Male patients with acute cholecystitis are older, have more comorbidities, and are more likely to have gangrenous cholecystitis than female patients. Despite these differences, operative outcomes and postoperative morbidity and mortality are similar between male and female patients.