Introduction: The purpose of this study was to determine the incidence of gallbladder perforation in a VA patient population presenting with acute cholecystitis and evaluate the impact of multiple risk factors including BMI on the risk of perforation.
Methods: This is a retrospective study of patients identified by a computer database (CPRS) undergoing cholecystectomy between 2007-2009. All patients who had a cholecystectomy for acute cholecystitis or gallbladder perforation were enrolled. Variables evaluated included demographic data, BMI, diabetes status, type of surgery, length of symptoms, imaging results, pathology results, and length of hospital stay. Significance was determined using chi-square test or T-test as appropriate.
Results: 69 patients with acute cholecystitis were identified. Mean patient age was 61years (range 40-86 years). 60/69(87%) patients were male. The incidence of gangrenous cholecystitis was 20/69 (29%) and gallbladder perforation was 4/69 (5.8%). The majority of patients with perforations were hispanic. The incidence of diabetes was 18/69(26%), and did not show a significant difference in the perforated vs. non-perforated patient population. Approximately 50% of the patients were obese. There was a significantly lower incidence of perforation in the obese patients (mean BMI 25.7±2.8 vs. 31.7±6.2, perforated vs. non-perforated respectively).
|Perforations (n=4)||64±7||4/0||1/3/0/0||25.7±2.8||2 (50%)||3(75%)|
|Gangrenous (n=20)||60±12||18/2||7/11/1/1||31.8±5.6||4 (20%)||14(70%)|
|Acute Cholecystitis(n=45)||61±13||38/7||28/13/3/1||31.7±6.6||12 (26.7%)||36(80%)|
|W=White, H=Hispanic, B=Black, A=Asian|
(n = 34)
(n = 35)
|Perforated||4 (11.8%)||0 (0%)|
|Non-perforated||30 (88.2%)||35 (100%)||0.037|
Conclusions: Gallbladder perforation is a rare entity but may have a much higher incidence in the older male VA patient population. Counterintuitively, patients presenting with acute cholecystitis with perforation had a lower BMI than those who were not perforated. These data indicate that early intervention should be considered in the treatment of non-obese older male patients presenting with acute cholecystitis.
Program Number: P431