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MANagement of Gallstone disease in the Older patient (MANGO): clinical and quality of life outcomes from a prospective multicentre cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月8日

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  • Anna E. Fairclough,
  • Ana D. Gavrila,
  • Charlotte Cossins,
  • Simon K. C. Toh,
  • Alexander R. Darbyshire,
  • Amy Lord,
  • Ayman Darwich,
  • Louise Finch,
  • Atilla Emin,
  • Charlotte Parfitt,
  • Malcolm West,
  • John Primrose,
  • Charles West,
  • Oliver Pickering,
  • Vikash Dodhia,
  • Charlotte Parfitt,
  • Raymond Chaorui Li,
  • Alison Ferguson,
  • Noha Al-Makadma,
  • Samuel McKoy,
  • Orla Busby,
  • Phoebe Carter,
  • Michael Woyton,
  • Vishnu Suresh,
  • Nathan Curtis,
  • Madeleine Taylor,
  • Manish Gupta,
  • Ulysses Hechanova,
  • Thomas Knowles,
  • Aseem Shah,
  • Sarita Agte,
  • Georgina Belt,
  • Stephanie Hannabus,
  • Godwin Dennison,
  • Vimal Mahendran,
  • Nigel Beer,
  • Lucy Pippard,
  • Kate Beesley,
  • Linda Howard,
  • Alison Lewis,
  • Jess Perry,
  • Fenella Welsh,
  • Mark Sidhom,
  • Rikhilroy Patel,
  • Rosin Kelly,
  • Joanne McClintock,
  • Joseph Doyle,
  • Christian Wakefield,
  • Bhavik Patel,
  • Simran Chhugani,
  • Nathan Grundy,
  • Arpita Devashetty,
  • Joanne McClintock,
  • Luca Bonomo,
  • Claire Osey,
  • Chloe Bascombe,
  • Cheryl Lindsay,
  • Javen Ramsami,
  • Suzanne Roffe,
  • Lindsay Rogers,
  • Luca Bonomo,
  • Karen O’Toole,
  • Matthew Bayliss,
  • Charlotte Humphrey,
  • Natasha Tamjidi,
  • Damian Mayo,
  • Alpha Anthony,
  • Luke Bennett,
  • Holly Morgan,
  • Kate Seymour,
  • Fiona Trim

摘要

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.