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CMAJ • May 16, 2000; 162 (10)
© 2000 Canadian Medical Association or its licensors

Research
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Postmenopausal estrogen replacement therapy and increased rates of cholecystectomy and appendectomy

Muhammad M. Mamdani*{dagger}, Karen Tu*{ddagger}¶**, Carl van Walraven*{dagger}{dagger}, Peter C. Austin*§ and C. David Naylor*{ddagger}

From *the Institute for Clinical Evaluative Sciences, Toronto, Ont.; the Faculties of {dagger}Pharmacy and {ddagger}Medicine and the Departments of §Public Health Sciences and ¶Family and Community Medicine, University of Toronto, Toronto, Ont.; **the University Health Network, The Toronto Hospital - Western Division, Toronto, Ont.; and {dagger}{dagger}the Department of Medicine, University of Ottawa, and the Clinical Epidemiology Unit, Loeb Health Research Institute, Ottawa Hospital, Ottawa, Ont.

Background: Several studies have indicated that estrogen may prime inflammatory and nociceptive pathways, leading to symptoms that mimic cholecystitis. We set out to confirm the relation between recent estrogen use and cholecystectomy in postmenopausal women and to test the novel hypothesis that a similar relation exists for appendectomy.

Methods: We developed a retrospective cohort using prescribing and surgical procedure information from health administrative databases for approximately 800 000 female residents of Ontario who were over 65 years of age between July 1, 1993, and Mar. 31, 1998. We compared the incidence of cholecystectomy and appendectomy among women recently prescribed estrogen replacement therapy, levothyroxine and dihydropyridine calcium-channel antagonists (DCCA) using age-adjusted Cox proportional hazards models. Patients were followed for a mean of 540 (standard deviation [SD] 449) days.

Results: Compared with women taking DCCA, those who had recently begun taking estrogen were significantly more likely to undergo cholecystectomy (age-adjusted risk ratio [aRR] 1.9, 95% confidence interval [CI] 1.6-2.2) and appendectomy (aRR 1.8, 95% CI 1.1-3.0). No significant difference in either outcome measure was found between the levothyroxine users and the DCCA users.

Interpretation: This study identifies an increased risk of cholecystectomy and appendectomy among postmenopausal women who have recently begun estrogen replacement therapy.




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