Increased morbidity in surgical patients undergoing secondary (incidental) cholecystectomy

Using computerized hospital discharge abstracts for all Vermont residents hospitalized during 1983 and 1984, we examined the question of whether increased morbidity occurs in patients undergoing secondary (incidental) cholecystectomy. Among a cohort of 4183 patients undergoing a primary surgical procedure in which secondary cholecystectomy might have been considered. 69 patients had a secondary cholecystectomy. The surgical wound infection rate was 8.7% in the secondary cholecystectomy group compared to 2.4% in the rest of the cohort (relative risk, 3.7, 95% C.I. 1.7, 8.1). Other postoperative complications occurred in 10.1% of those undergoing secondary cholecystectomy compared to 4.1% in those who did not (relative risk, 2.5, 95% C.I. 1.2, 5.1). The adjusted relative risk for wound infection was 3.3 (95% C.I. 1.4,8.0) and for other surgical complications was 1.7 (95% C.I. 0.8, 3.8). Postoperative length of hospital stay was longer for the secondary cholecystectomy group (mean, 13.8 days) than in the comparison group (mean 8.9 days, p = 0.001). These data suggest that patients undergoing a secondary cholecystectomy may have an increased risk of surgical wound infection and possibly other surgical complications.