Yen-Yi Juo, MD, MPH1, Usah Khrucharoen, MD2, Yijun Chen, MD1, Yas Sanaiha, MD1, Peyman Benharash, MD1, Erik Dutson, MD1. 1UCLA, 2Veteran Affairs Greater Los Angeles Area
Background: Besides rate and extent of weight loss, little is known regarding factors predicting interval cholecystectomy following bariatric surgery, which are important factors in a surgeon's consideration during decision-making regarding whether to perform prophylactic cholecystectomy. In addition, no previous studies have quantified the incremental costs associated with IC. We aim to identify risk factors predicting interval cholecystectomy (IC) following bariatric surgery and quantify its costs.
Methods: A retrospective cohort study was performed using the National Readmission Database 2010-2014. Cox proportional hazard analyses were used to identify risk factors for IC. Linear regression models were constructed to examine associations between cholecystectomy timing and cumulative hospitalization costs.
Results: An estimated national total of 553,658 patients received bariatric surgery during the study period. Of these, 3.3% received concomitant cholecystectomy (CC). After adjusting for bariatric procedure type, age, gender, complication and length of stay, CC was independently associated with an $1,589 increase in hospitalization cost (95% Confidence Interval $1,021-2,158, p<0.01). Of patients that received no CC, only 0.06% underwent IC during the up-to-one-year follow-up. Age below 35 (p<0.01), female gender (p<0.01), and high preoperative BMI (p=0.03) were all risk factors for IC. IC was independently associated with a $1,499 higher cumulative hospitalization cost than CC (p<0.01, 95% Confidence Interval $844-$2,154).
Conclusions: Despite the higher absolute cost of IC, its low incidence does not financially justify a routine prophylactic CC approach. In addition, no significant reduction in cholecystectomy-related complications were achieved by performing CC. An individualized approach taking identified risk factors for IC into consideration is recommended when deciding whether to perform prophylactic CC.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86663
Program Number: P554
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster