{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:42:48Z","timestamp":1793835768325,"version":"4.6.1"},"reference-count":21,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100009230","name":"landstinget i uppsala l\u00e4n","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009230","id-type":"DOI","asserted-by":"publisher"}]},{"name":"G\u00e4vleborg County Council","award":["CFUG-9788509"],"award-info":[{"award-number":["CFUG-9788509"]}]},{"name":"G\u00e4vleborg County Council","award":["CFUG-978856"],"award-info":[{"award-number":["CFUG-978856"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Scand J Surg"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Early cholecystectomy improves outcomes in acute cholecystitis, yet surgeons often hesitate to operate on elderly and multimorbid patients, and prospective data in this group are lacking. This cohort study compared outcomes across hospitals with differing operative policies to estimate the effect of surgery among the elderly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Retrospective data using the Swedish National Inpatient Register, including 12,481 patients aged\u2009\u2a7e\u200970\u2009years treated for cholecystitis between 2015 and 2019, were analyzed. Outcomes included all-cause and gallstone-related mortality, length of stay related to gallstone disease during the index admission, and within 1 and 3\u2009years. Hospitals and counties were categorized into quartiles based on cholecystectomy rates (Q1\u2009=\u2009lowest, Q4\u2009=\u2009highest). Survival was assessed using Cox proportional hazards regression. Length of stay was analyzed with linear regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Patients treated at Q1 hospitals were slightly older but had similar comorbidity burdens compared to Q4 hospitals. Surgical rates ranged from 25% to 60%. Overall mortality was lower in Q4 counties, but not significantly different at hospital level (hazard ratio (HR)\u2009=\u20090.86 95% confidence interval (CI)\u2009=\u20090.77\u20130.96). Gallstone-related mortality did not differ across quartiles. Although the index admission length of stay was similar, cumulative length of stay at 1 and 3\u2009years was shorter for patients treated at Q4 hospitals compared to Q1 (0.87 fewer days at 3\u2009years; 95% CI\u2009=\u20090.39\u20131.34).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Hospitals with higher cholecystectomy rates did not demonstrate lower mortality, but regions with higher surgical rates showed improved survival. Higher operative rates were associated with fewer recurrences and reduced cumulative length of stay, suggesting that increased use of cholecystectomy benefits both patients and healthcare systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration:<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/14574969261431971","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T09:09:06Z","timestamp":1773911346000},"page":"177-184","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Cholecystectomy or non-operative management for cholecystitis in elderly patients: An analysis based on hospital practice patterns"],"prefix":"10.1177","volume":"115","author":[{"given":"Maria","family":"S\u00f6derstr\u00f6m","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences, Uppsala University, Uppsala, Sweden"},{"name":"Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olov","family":"Norl\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Uppsala University, Uppsala, Sweden"},{"name":"Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrik","family":"Linder","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Uppsala University, Uppsala, Sweden"},{"name":"Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1621-7872","authenticated-orcid":false,"given":"Erik","family":"Osterman","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences Uppsala University 751 85 Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-016-0082-5"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.516"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-38428-z"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-022-02453-0"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgast-2024-001680"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2014.12.012"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2009.12.031"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182788e4d"},{"key":"e_1_3_3_10_2","doi-asserted-by":"crossref","unstructured":"Acker RC Ginzberg SP Sharpe J et al: Operative vs nonoperative treatment of acute cholecystitis in older adults with multimorbidity. JAMA Surg [Internet]. 2025;160:656\u2013664 https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2832717","DOI":"10.1001\/jamasurg.2025.0729"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-019-07095-0"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3182507646"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/14574969231178650"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-018-3210-y"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2019.06.003"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-450"},{"key":"e_1_3_3_18_2","unstructured":"NOMESCO classification of surgical procedures version 1.15. 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