Prophylactic cholecystectomy or expectant management for silent gallstones. A decision analysis to assess survival.

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.