Factors that Predict the Need for Subtotal Cholecystectomy.

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical Outcomes Research

Background:

• Subtotal cholecystectomy is a critical "damage control" procedure for complex gallbladder surgeries.
• Rising national rates of subtotal cholecystectomy highlight its increasing importance.
• Severe inflammation and distorted anatomy increase surgical risks, necessitating alternative techniques.

Purpose of the Study:

• To identify patient-specific factors and provider experience associated with subtotal cholecystectomy performance.
• To analyze trends in subtotal cholecystectomy over a four-year period.

Main Methods:

• Retrospective review of 916 cholecystectomies performed between 2016 and 2019.
• Collection of patient demographics, laboratory values, imaging, diagnoses, and surgical techniques.
• Multivariable regression analysis to determine factors influencing subtotal cholecystectomy likelihood.

Main Results:

• Subtotal cholecystectomy was performed in 86 (9.4%) of cases.
• Older age (aOR 1.23), male sex (aOR 2.59), elevated white blood cell count > 10.3 (aOR 2.02), and acute on chronic cholecystitis diagnosis (aOR 5.47) significantly increased the likelihood.
• Attending surgeon experience (≤5 vs. >5 years) did not significantly impact the likelihood of performing subtotal cholecystectomy (OR 0.66).

Conclusions:

• Patient factors including older age, male sex, elevated WBC, and specific diagnoses are associated with increased subtotal cholecystectomy rates.
• Surgeon experience level does not appear to influence the decision to perform subtotal cholecystectomy.
• Subtotal cholecystectomy serves as an operative strategy across all surgeon experience levels for severe gallbladder pathology.