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THE EFFECT OF PRIOR ULTRASOUND ON OUTCOMES IN ACUTE VERSUS ELECTIVE LAPAROSCOPIC CHOLECYSTOMY

Young Lee, MD, MSc, Arjun Chandrasekaran, MD, MSMPh, Gonzalo Ausqui, MD, Connor McGinley, BS, Pratibha Vemulapalli, MD, FACS, Luca Milone, MD, PhD. The Brooklyn Hospital Center

Patients who received ultrasound prior to admission for acute cholecystitis were compared with patients who presented electively for LC. Laparoscopic cholecystectomy (LC) is the gold standard operation for gallbladder disease. It is one of the most common operations performed on emergency services in the United States. Many patients receive diagnostic ultrasound imaging prior to presentation but are not operated on immediately. 

Methods: This is a retrospective study analyzing all of the laparoscopic cholecystectomies performed at The Brooklyn Hospital Center (TBHC), both emergent and elective, from 2016 – 2017. Patient data was collected on demographics, comorbidities, operative findings, complications, length of stay (LOS), and 30 day readmission.  Statistical analysis was performed using IMB SPSS Statistics v. 19.  Covaried analysis of variance (ANCOVA) was performed on continues variables and significance levels were calculated.  Pearson’s Chi Square significance level was calculated for all binomial variables.

Results: Of the 281 patients who underwent LC during this time period, 152 cases presented electively and 139 presented acutely.  Of the patients who presented acutely, 20 had ultrasound prior to admission.  There was no statistically significant difference between patients who presented acutely with a prior ultrasound and patients who presented electively for LC when comparing operative time (OR time), complication rates, LOS, and 30 day readmission rates.  Acute cases (with NO prior ultrasound) were still associated with a statistically significantly increased length of stay (LOS) 3.5 days vs. 0.4 days for elective (p < 0.05) as well as a statistically significantly increased OR time 135 minutes vs. 119 for elective (p = 0.002).  Complication rates and 30 day readmission rates did not differ significantly between acute and elective cases.

Conclusions: We found that receiving prior ultrasound in patients who presented acutely appears to have no statistically or clinically significant effect on OR time, complication rates, LOS, and 30 day readmission rates when compared to patients who presented for LC electively. However, there was a statistically and clinically significant increase in OR time and LOS in acute vs. elective cases in general.  Thus, it is possible that having prior symptomatic disease, as indicated by prior ultrasound testing, appears to confer a protective advantage to this group. Larger prospective studies evaluating the effect of prior symptomatic disease on operative findings, complication rates, LOS and 30 day readmission rates when patients present acutely and undergo LC are needed to analyze these effects further.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88351

Program Number: P126

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

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