MANagement of Gallstone disease in the Older patient (MANGO): clinical and quality of life outcomes from a prospective multicentre cohort study
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Journal Article
Abstract
Background: Gallstones commonly cause emergency surgical admission in older adults and are frequently associated with complications. Although cholecystectomy is recommended in the general population, decision-making is complicated by increased comorbidity and frailty in older patients.
Methods: Trainee-led prospective multicentre cohort across nine NHS hospitals. Consecutive emergency admissions in patients aged ≥70 years with radiologically confirmed gallstone disease were recruited (November 2022–March 2024). Data were collected at baseline, 30-days and 1-year, including Gastrointestinal Quality of Life Index (GIQLI) scores.
Results: Of 194 patients, 36 (18.6%) underwent emergency cholecystectomy, with 158 (81.4%) managed non-operatively at initial presentation. The non-operative group had greater comorbidity burden and frailty. All emergency operations were started laparoscopically (one conversion) with no major complications; median length of stay was similar (7 vs 5 days, p=0.105).
Gallstone-related readmission at 1-year was higher after non-operative management (23.0% vs 2.9%, p=0.024); non-biliary readmissions were similar. One-year mortality was 12.4% vs 0% (p=0.06). Baseline GIQLI was similar. At 30-days, emergency cholecystectomy was associated with the greatest difference in GIQLI score compared to the non-operative group (p≤0.007). At 1-year, GIQLI remained higher after emergency cholecystectomy (123.8 vs 115.6, p=0.039). Forty-three patients had undergone interval cholecystectomy by 1-year.
Conclusion: Emergency cholecystectomy in older patients deemed suitable for surgery is associated with reduced gallstone-related re-admissions at 1-year and higher QoL scores. These findings support consideration of surgery in appropriately selected older patients and further randomised research in this higher risk group.
Methods: Trainee-led prospective multicentre cohort across nine NHS hospitals. Consecutive emergency admissions in patients aged ≥70 years with radiologically confirmed gallstone disease were recruited (November 2022–March 2024). Data were collected at baseline, 30-days and 1-year, including Gastrointestinal Quality of Life Index (GIQLI) scores.
Results: Of 194 patients, 36 (18.6%) underwent emergency cholecystectomy, with 158 (81.4%) managed non-operatively at initial presentation. The non-operative group had greater comorbidity burden and frailty. All emergency operations were started laparoscopically (one conversion) with no major complications; median length of stay was similar (7 vs 5 days, p=0.105).
Gallstone-related readmission at 1-year was higher after non-operative management (23.0% vs 2.9%, p=0.024); non-biliary readmissions were similar. One-year mortality was 12.4% vs 0% (p=0.06). Baseline GIQLI was similar. At 30-days, emergency cholecystectomy was associated with the greatest difference in GIQLI score compared to the non-operative group (p≤0.007). At 1-year, GIQLI remained higher after emergency cholecystectomy (123.8 vs 115.6, p=0.039). Forty-three patients had undergone interval cholecystectomy by 1-year.
Conclusion: Emergency cholecystectomy in older patients deemed suitable for surgery is associated with reduced gallstone-related re-admissions at 1-year and higher QoL scores. These findings support consideration of surgery in appropriately selected older patients and further randomised research in this higher risk group.
Date Acceptance
2026-05-18
Citation
BMC Surgery
ISSN
1471-2482
Publisher
BMC
Journal / Book Title
BMC Surgery
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
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Publication Status
Accepted