Is the Risk of Operating on Acute Cholecystitis Too Great? a Comparison of National Outcomes Following Laparoscopic Cholecystectomy

Emily Benham, Samuel W Ross, MD, MPH, Ciara R Huntington, MD, Peter E Fischer, MD, MS, John M Green, MD, Bradley W Thomas, MD, B. Todd Heniford, MD, A. Britton Christmas, MD, Ronald F Sing, DO. Carolinas Medical Center

Introduction: Many HPB experts and the Tokyo guidelines recommend delaying cholecystectomy for advanced acute cholecystitis, given an increased risk of complications, and operating when in a chronic phase. Therefore, our goal was to use national data to examine risk of post-operative complications following laparoscopic cholecystectomy (LC) for acute vs. chronic cholecystitis.

Methods and Procedures: The ACS NSQIP database was queried for all LC from 2005-2013. Two cohorts were defined by diagnosis codes acute cholecystitis (AC) chronic cholecystitis (CC). Univariate tests were used to compare the cohorts. Multivariate analysis was performed for outcomes controlling for age, BMI, gender, diabetes, smoking, and Charlson Comorbidity Index. Conversion rate and common bile duct injury are not tracked in NSQIP.

Results: There were 145,644,520 LC: 44,436 with IOC and 1,168 with common bile duct exploration.  LC was performed for AC in 46,189 cases and 99,455 for CC. Complication rates were low: wound complication 0.77%, intra-abdominal abscess 0.45%, reoperation 0.94%, readmission 4.40%, and 30 day mortality 0.23%. The AC cohort had older, more male, higher BMI, more inpatient, diabetics, and higher CCI; p<0.001 for all. Univariate outcomes are reported in the table, and all complications, except for superficial SSI, and mortality were higher in the AC cohort. On multivariate analysis, LC for AC had an increased odds of reoperation (OR, CI: 1.36, 1.16-1.60), readmission (1.33, 1.23-1.43), intra-abdominal abscess (2.19, 1.87-2.56), and 30 day mortality (1.78, 1.42-2.22) when compared to LC for CC.

Conclusions: Rates of 30 day complications are low for laparoscopic cholecystectomy, but, they are slightly increased when performed for acute compared to chronic cholecystitis.  Surgeons and patients should balance these minimally increased risks with the cost, discomfort, and healthcare resources associated with delaying cholecystectomy.

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