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Relationship Between Persistence of Abdominal Symptoms and Successful Outcome After Cholecystectomy
Craig R. Weinert, MD, MPH;
Donna Arnett, PhD;
David Jacobs, Jr, PhD;
Robert L. Kane, MD
Arch Intern Med. 2000;160:989-995.
Background Patients frequently have persistent abdominal symptoms after undergoing cholecystectomy. The relationship between abdominal symptoms and biliary dysfunction is often unclear.
Objectives To describe the persistence rate of abdominal symptoms in a large cohort of patients after elective cholecystectomy, to identify predictors of symptom persistence and operative success, to understand which symptoms improve after cholecystectomy, and to describe the important determinants of an unsuccessful operation.
Methods Secondary analysis of a prospective, multisite cohort study of 2481 patients undergoing elective cholecystectomy.
Results The mean ± SD number of abdominal symptoms per patient decreased from 3.1 ± 2.0 to 1.1 ± 1.3; 27% of patients who identified a symptom as most bothersome before surgery still had the symptom 6 months after surgery. Symptom persistence rates ranged from 5.6% (vomiting) to 40.2% (gas/flatulence). A balance score that quantified the abdominal symptom mix between dyspeptic and biliary symptoms shifted after surgery to the dyspeptic category. Predictors of persistence of a most bothersome symptom were dyspeptic symptom category, worse operative risk and self-rated health status, symptom duration longer than 6 months, and no previous episodes of acute cholecystitis. The major correlate of not achieving a very successful outcome (15.2% of patients) was the presence of postoperative abdominal pain. Other predictors included worse self-rated health status and physical functioning, symptom duration longer than 6 months before surgery, and no previous episodes of acute cholecystitis.
Conclusions Symptoms categorized as dyspeptic were more likely to persist than were biliary symptoms, although all symptoms showed a decrease in prevalence after cholecystectomy. More attention to the rationale for gallbladder removal and clarification of patient expectations for symptom relief might be necessary to improve outcomes after elective cholecystectomy.
From the Clinical Outcomes Research Center (Drs Weinert, and Kane), the Department of Medicine, Medical School (Dr Weinert), and the Divisions of Epidemiology (Drs Arnett and Jacobs) and Health Services Research and Policy (Dr Kane), School of Public Health, University of Minnesota, Minneapolis.
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