title: Influence of gender and socioeconomic background on the decision to perform gallstone surgery: a population-based register study.
abstract: BACKGROUND
  In the absence of unequivocal standardized indications for surgery, socioeconomic background and gender may have a major impact on the decision to perform surgery for cholecystolithiasis. The purpose was to assess how decisions to perform surgery in Sweden are influenced by patient-related factors and how this affects the epidemiology of gallstone disease.
  
  
  METHODS
  This study is based on the Swedish Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks), which covers >90% of surgical units, including 98% of all procedures performed. All procedures performed during 2005-2009 were included. Data on socioeconomic background were obtained from Statistics Sweden. The influence of gender and age on decision to perform surgery was tested in multivariate linear regression analysis.
  
  
  RESULTS
  Up to the age of 40 years, women were 6 times more likely than men to undergo surgery for biliary colic. On the other hand, there was a relative preponderance of men undergoing cholecystectomy for jaundice, cholecystitis, bile duct stone or pancreatitis in the elderly population (p < 0.001). Socioeconomic background did not have any significant impact on the decision to operate.
  
  
  CONCLUSIONS
  Presentations of gallstone disease differ between men and women, as does the decision to perform surgery. The higher incidence of surgery for secondary complications in older men could be explained by a higher prevalence of gallstones resulting from a lower incidence of surgery at a younger age. Whether or not wider indications for surgery in young patients reduce the risk for gallstone complications requiring surgery should be explored in future studies.
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital , Östra, Gothenburg , Sweden.
authors.forename: Simon H
authors.initials: SH
authors.lastname: Pålsson
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandblom
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D041881:Cholecystitis, Acute / Q000601:surgery; D041761:Cholecystolithiasis / Q000601:surgery*; D003657:Decision Making; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007565:Jaundice / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000601:surgery; D011159:Population Surveillance; D012044:Regression Analysis; D017678:Sex Distribution; D012923:Social Class; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: ERCP; biliary-basic; biliary-clinical; hepatobiliary-clinical; laparoscopy