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Diagnosis and Treatment |

Prophylactic Cholecystectomy or Expectant Management for Silent Gallstones: A Decision Analysis to Assess Survival

DAVID F. RANSOHOFF, M.D.; WILLIAM A. GRACIE, M.D.; LEWIS B. WOLFENSON, Ph.D.; and DUNCAN NEUHAUSER, Ph.D.
[+] Article and Author Information

Presented in part at the American Gastroenterological Association Meetings, Chicago, Illinois, 1982.

▸Requests for reprints should be addressed to David F. Ransohoff, M.D.; University Hospitals of Cleveland, 2074 Abington Road; Cleveland, OH 44106.


Cleveland, Ohio; and Ann Arbor, Michigan


© 1983 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1983;99(2):199-204. doi:10.7326/0003-4819-99-2-199
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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.

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