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u/WohowudothatonReddit2d ago
Complication rates in cholecystectomy declining in elderly (Medicare) patients from 2011-2021
Mullens CL, Sinamo JK, Hallway A, Sheetz KH, Ehlers AP, Telem DA. Contemporary Outcomes of Cholecystectomy. JAMA Surg. 2026;161(4):398–405. doi:10.1001/jamasurg.2025.6865
>Morbidity from cholecystectomy ranges from 10% to 20%,1,2 yet recent research efforts have disproportionately focused on rare but high-stakes complications such as bile duct injury, which occurs in approximately 0.3% of patients.3,4 In recent decades, there has been increased attention on reducing overall morbidity from this common procedure.
I thought it was nice to see that we can continue to make one of the most common procedures safer, especially in the elderly population. The cholecystectomy is often seen as "no big deal" by patients and many doctors, but the seasoned general surgeon knows otherwise! I've heard a few accurate sayings, such as "There are no friends in the right upper quadrant" or "It's a nickel-and-dime operation with a million dollar complication."
A bile duct injury is the biggest concern, but hematomas, abscesses, retained bile duct stones, duodenal/colon injuries, hernias, and more are all possible.
One of the possible reasons for a decrease in injury is the rise of cholecystostomy tubes. I see that as a double-edged sword. Some of the worst cholecystectomies I've ever done were after a cholecystostomy tube. Acute inflammation is like cleaning up wet cement. Chronic inflammation is like cleaning up hardened concrete. The acute inflammation is often bloody, but the dissection planes reveal themselves with some blunt dissection and suction. Chronic inflammation has to be cut sharply or cauterized, and you might not realize you're in trouble until too late. The last time I referred a patient for a cholecystostomy tube was when the cardiologist flat out told me the patient couldn't have general anesthesia. Not a tough choice there, but almost everyone else I will try to take for the definitive procedure.
Indocyanine green (ICG) has also been a great help. Being able to flip on a fluorescent mode and see where the common bile duct is hiding is like having x-ray vision. I've been using it since ~2019 or 2020, and I'd never want to go back.
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Analysis Summary
A peer-reviewed JAMA Surgery study from 2026 shows complication rates from gallbladder removal have declined in elderly Medicare patients over the past decade, even though the procedure carries 10–20% baseline morbidity risk and involves serious potential complications beyond the well-known bile duct injury. The post author, a surgeon, contextualizes this finding through clinical experience, noting that while bile duct injuries remain rare at 0.3%, the procedure is more dangerous than patients typically assume — and that temporary drainage tubes, while possibly contributing to improved outcomes overall, can paradoxically create harder surgical conditions if patients later need full removal due to chronic inflammation.
Claims Analysis (5)
“Complication rates in cholecystectomy declining in elderly (Medicare) patients from 2011-2021”
JAMA Surgery 2026 peer-reviewed study directly confirms declining morbidity trends in elderly cholecystectomy patients over this period.
“Morbidity from cholecystectomy ranges from 10% to 20%”
Cited directly from the JAMA Surgery article abstract as established baseline complication rate.
“Bile duct injury occurs in approximately 0.3% of patients”
Exact statistic cited from JAMA Surgery article; standard figure in surgical literature.
“Rise of cholecystostomy tubes is one possible reason for decreased injury rates”
Author's professional interpretation of mechanism behind complication decline; plausible but not explicitly stated in the cited study.
“Chronic inflammation from cholecystostomy tubes makes subsequent surgery more complex than acute inflammation”
Experienced surgeon's clinical observation based on operative experience; consistent with surgical consensus but presented as personal insight.
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