Predictive Factors for Cholecystectomy in Bariatric Patients Undergoing Medically-supervised Weight Loss

Alan Berg, MD, Jean-Claude Gauthier, MD, Fatima Haggar, MPH, PhD, Tinghua Zhang, MSC, Robert Dent, MD, Jean-Denis Yelle, MD, Isabelle Raiche, MD, N’Gai Porte, MD, Joseph Mamazza, MD

Division of General Surgery, the Ottawa Hospital, University of Ottawa, the Ottawa Hospital Research Institute

Introduction

The objective of this study was to determine the prevalence of cholecystectomy in obese patients enrolled in a rapid weight loss program and to identify factors associated with an increased risk for requiring cholecystectomy.

Methods

We included data from 3436 patients enrolled in a medically-supervised weight loss program at the Weight Management Clinic, the Ottawa Hospital between 1992 and 2008. All patients who had a cholecystectomy prior to initiation of the weight loss program were excluded. We prospectively collected detailed historical, clinical, and laboratory data. Objective measurements and responses to standardized questionnaires were collected during clinic visits. A univariate analysis was performed to identify patient factors that were associated with cholecystectomy. A multivariate analysis was then performed to identify independent predictors of this outcome.

Results

Of the 3436 patients enrolled into the Weight Management Clinic at The Ottawa Hospital, 585 (17%) had a cholecystectomy prior to enrolment into the program. A total of 2851 patients were included in the final analysis. The overall prevalence of cholecystectomy in our population was 9%. Multivariate analysis revealed six variables that were independent predictors of cholecystectomy (p-value ≤ 0.05): Incremental BMI increase of 5, rate of weight loss > 1.5 kg/week, serum triglycerides >1.7 mmol/L, menstruating females, oral contraceptives and hormone-replacement therapy. Two factors, total bilirubin > 17 μmol/L and lipid-lowering drugs, were associated with significant reductions in the incidence of cholecystectomy. Factors that had no influence included gender, prior pregnancy, and serum total cholesterol >5.2 mmol/L.

Conclusion

Multiple patient factors were found to be associated with an increased risk of requiring cholecystectomy in individuals undergoing rapid medical weight loss. Future studies should determine if these factors could be predictive of who will develop symptomatic cholelithiasis and require cholecystectomy in the bariatric surgery population. This knowledge would be helpful to guide decision-making for surgeons who are considering when to offer concomitant cholecystectomy at the time of bariatric surgery.

Session: Podium Presentation

Program Number: S009