title: Mortality associated with the treatment of gallstone disease: a 10-year contemporary national experience.
abstract: BACKGROUND
  Gallstones remain a common clinical problem requiring skilled operative and nonoperative management. The aim of the present population-based study was to investigate causes of gallstone-related mortality in Scotland.
  
  
  METHODS
  Surgical deaths were peer reviewed between 1997 and 2006 through the Scottish Audit of Surgical Mortality (SASM); data were analyzed for patients in whom the principal diagnosis on admission was gallstone disease.
  
  
  RESULTS
  Gallstone disease was responsible for 790/43,271 (1.83%) of the surgical deaths recorded, with an overall mortality for cholecystectomy of 0.307% (176/57,352), endoscopic retrograde cholangiopancreatography (ERCP) of 0.313% (117/37,345), and cholecystostomy of 2.1% (12/578) across the decade. However, the majority of patients who died were elderly (47.6% ≥ 80 years or older) and were managed conservatively. Deaths following cholecystectomy usually followed emergency admission (76%) and were more likely to have been associated with postoperative medical complications (n = 189) than surgical complications (n = 36).
  
  
  CONCLUSIONS
  Although cholecystectomy is a relatively safe procedure, patients who die as a result of gallstone disease tend to be elderly, to have been admitted as emergency cases, and to have had co-morbidities. Future combined medical and surgical perioperative management may reduce the mortality rate associated with gallstones.
authors.affiliation: Department of Surgery, Ninewells Hospital and Medical School, Dundee D1 9SY, UK. john.scollay@nhs.net
authors.forename: John M
authors.initials: JM
authors.lastname: Scollay
authors.forename: Russell
authors.initials: R
authors.lastname: Mullen
authors.forename: Gillian
authors.initials: G
authors.lastname: McPhillips
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods / Q000401:mortality; D002763:Cholecystectomy / Q000379:methods / Q000401:mortality*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom