Gender Comparison of Receipt of Government-Funded Health Services and Medication Prescriptions for the Management of Patients With Cardiovascular Disease in Primary Care

Factors Affecting Early Cholecystectomy for Acute Cholecystitis in Older People-A Population-Based Study

OBJECTIVES

Acute cholecystitis is one of the most common surgical presentations in Australia and increases with age. Guidelines recommend early laparoscopic cholecystectomy (within 7 days), as it results in shorter length of stay, reduced costs and readmission rates. Despite this, there is a perception that early cholecystectomy may result in higher morbidity and conversion to open surgery in older patients. Our objective is to report the proportion of early versus delayed cholecystectomy in older patients in New South Wales (NSW), Australia, and to compare health outcomes and factors influencing variation.

DESIGN

This is a retrospective population-based cohort study of all cholecystectomies for primary acute cholecystitis in NSW residents aged >50, between 2009 and 2019. The primary outcome was the proportion of early versus delayed cholecystectomy. We used multilevel multivariable logistic regression analyses adjusted for age, sex, comorbidities, insurance status, socio-economic status and hospital characteristics.

RESULTS

A high rate (85%) of the 47,478 cholecystectomies in older patients were performed within 7 days of admission. Delayed surgery was associated with increasing age and comorbidity, male sex, Medicare-only insurance and surgery in low- or medium-volume centres. Early surgery was associated with shorter overall length of stay, fewer readmissions, less conversion to open surgery and lower bile duct injury rates.

CONCLUSION

A high proportion of adults with cholecystitis are undergoing early cholecystectomy in NSW. Our results support the efficacy of early cholecystectomy in older patients and identify potentially modifiable factors relevant to health care professionals and policymakers.

Age-Related Variation in the Provision of Primary Care Services and Medication Prescriptions for Patients with Cardiovascular Disease

As population aging progresses, demands of patients with cardiovascular diseases (CVD) on the primary care services is inevitably increased. However, the utilisation of primary care services across varying age groups is unknown. The study aims to explore age-related variations in provision of chronic disease management plans, mental health care, guideline-indicated cardiovascular medications and influenza vaccination among patients with CVD over differing ages presenting to primary care. Data for patients with CVD were extracted from 50 Australian general practices. Logistic regression, accounting for covariates and clustering effects by practices, was used for statistical analysis. Of the 14,602 patients with CVD (mean age, 72.5 years), patients aged 65-74, 75-84 and ≥85 years were significantly more likely to have a GP management plan prepared (adjusted odds ratio (aOR): 1.6, 1.88 and 1.55, respectively, p < 0.05), have a formal team care arrangement (aOR: 1.49, 1.8, 1.65, respectively, p < 0.05) and have a review of either (aOR: 1.63, 2.09, 1.93, respectively, p < 0.05) than those < 65 years. Patients aged ≥ 65 years were more likely to be prescribed blood-pressure-lowering medications and to be vaccinated for influenza. However, the adjusted odds of being prescribed lipid-lowering and antiplatelet medications and receiving mental health care were significantly lowest among patients ≥ 85 years. There are age-related variations in provision of primary care services and pharmacological therapy. GPs are targeting care plans to older people who are more likely to have long-term conditions and complex needs.