SYMPTOMATIC CHOLELITHIASIS - A DIFFERENT DISEASE IN MEN

Objective To determine the importance of gender in the clinical presen tation and subsequent clinical outcome (risk of conversion from laparo scopic to open technique and risk of postoperative mortality) for pati ents undergoing cholecystectomy. Summary Background Data Age and clini cal presentation have consistently been found to be important predicto rs of cholecystectomy outcomes; male gender has been cited in disparat e studies as possibly having prognostic significance. Method A statewi de cholecystectomy registry (30,145 cases between 1989-1993) was analy zed. Hierarchical log-linear modeling was used to identify association s between characteristics of clinical presentation. Multivariate logis tic regression analysis was used to determine predictions of conversio n and mortality. Results Male gender was associated with twice the exp ected incidence of acute cholecystitis and pancreatitis in the elderly (greater than or equal to 65 years). Males had a significantly increa sed risk for conversion to open technique, but this decreased during t he time frame of the study. Mortality was twice as high among males (c onfidence interval, 1.4-2.9, p = 0.0001). Conclusions Males presenting for cholecystectomy are more likely to have severe disease. Independe nt of clinical presentation, they lace increased risks of conversion t o open technique and of postoperative mortality.