title: Prophylactic cholecystectomy or expectant management for silent gallstones. A decision analysis to assess survival.
abstract: Decision analysis was done to compare the consequences of prophylactic cholecystectomy with expectant management for silent gallstone disease. Probability values were derived from a study of the natural history of silent gallstone disease, published cholecystectomy mortality rates, and life tables. The two strategies were compared by calculating cumulative numbers of person-years lost for hypothetical cohorts of men and women. Prophylactic cholecystectomy slightly decreases survival. A 30-year-old man choosing prophylactic cholecystectomy instead of expectant management would lose, on average, 4 days of life; a 50-year-old man would lose 18 days. Consideration of monetary costs and discounting further disfavors prophylactic cholecystectomy. Sensitivity analysis shows that differences between the two strategies remain small over a broad range of probability values, both for men and women.
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001659:Biliary Tract / Q000503:physiopathology; D002763:Cholecystectomy / Q000009:adverse effects / Q000191:economics; D002769:Cholelithiasis / Q000401:mortality / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011336:Probability; D012737:Sex Factors