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TOPLINE:

Undergoing cholecystectomy at a younger age (< 40 years) was associated with higher long-term mortality, potentially influenced by higher alcohol use and smoking.

METHODOLOGY:

• This nationwide Swedish cohort study examined the long-term mortality outcomes after cholecystectomy in 159,946 adults (62.2% men) aged 20-79 years who underwent the procedure between 1969 and 2016.
• The patients were matched with 764,681 (62% men) control individuals from the general population who did not have gallbladder disease or undergo cholecystectomy.
• Information on deaths and comorbidities was obtained from national registers.
• The participants were followed for a median of 12 years.

TAKEAWAY:

• During the follow-up period, 38,401 deaths were reported in the cholecystectomy group, whereas 181,197 deaths occurred in the control group (adjusted hazard ratio [aHR], 0.91; 95% CI, 0.90-0.92), indicating a lower mortality risk after surgery.
• Cholecystectomy was associated with higher overall mortality in individuals aged 20-39 years (aHR, 1.42; 95% CI, 1.32-1.53) and those aged 40-49 years (aHR, 1.07; 95% CI, 1.02-1.13).
• Among the 1015 patients who underwent the surgery between the ages of 20 and 39 years and died during the follow-up period, alcohol-related diseases (12.2%) and smoking-related disorders (7.4%) were notably common.
• The risk for overall mortality was slightly reduced in patients older than 50 years at the time of cholecystectomy.

IN PRACTICE:

"Future studies are needed to investigate mechanisms of higher mortality among younger participants with cholecystectomy, and to identify measures to prevent these excess deaths in the population, our study suggests that obesity may be an important risk factor to target in this patient group," the authors wrote.

SOURCE:

This study was led by Louise Emilsson, Institute of Health and Society, University of Oslo, Oslo, Norway. It was published online on May 09, 2025, in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

The study was limited by its inability to adjust for postmenopausal hormone use and potential residual confounding from factors such as body mass index, diet, and alcohol consumption. Additionally, it could not differentiate between gallstone types or classify surgeries as elective or acute. Furthermore, with a predominantly European ancestry among participants, the findings require validation in non-European populations.

DISCLOSURES:

The study was supported by grants from FORTE. One author disclosed receiving financial support, being involved in other research collaborations, and coordinating other studies, with ties to pharmaceutical companies. Another author declared being an employee and stockholder of a pharmaceutical company.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.