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Elective laparoscopic cholecystectomy: recurrent biliary admissions predispose to difficult cholecystectomy
James Lucocq1, John Scollay2, Pradeep Patil2
1Department of General and Upper GI Surgery, Ninewells Hospital, University of Dundee, Dundee, UK. james.lucocq@nhs.scot.
Surgical Endoscopy
|January 13, 2022
Summary
Patients with recurrent biliary admissions, especially cholecystitis, face higher risks during elective laparoscopic cholecystectomy (ELLC). This includes complications, longer hospital stays, and readmissions, highlighting the need for individualized risk assessment before ELLC.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Health Services Research
Background:
- Elective laparoscopic cholecystectomy (ELLC) patient stratification is challenging due to heterogeneity.
- Pre-operative factors influencing adverse outcomes in ELLC require identification.
- Improved risk stratification can guide surgical decisions and enhance patient consent.
Purpose of the Study:
- To identify pre-operative factors associated with adverse peri- and post-operative outcomes in ELLC patients.
- To improve risk stratification for ELLC procedures.
- To inform surgical decision-making and the patient consent process.
Main Methods:
- Retrospective analysis of 2,166 ELLC patients from January 2015 to December 2019.
- Data linkage from multiple databases for pre-operative and outcome data.
- Multivariate regression models to identify predictors of adverse outcomes, comparing biliary colic vs. cholecystitis groups.
Main Results:
- Patients with cholecystitis had significantly higher rates of adverse outcomes compared to biliary colic.
- Increased cholecystitis admissions correlated with higher adverse outcomes (p < 0.05).
- Patients with ≥2 cholecystitis admissions showed high rates of subtotal procedures (29.5%), intra-operative (9.8%), and post-operative complications (19.6%), prolonged stay (45.9%), and readmission (16.4%).
Conclusions:
- Repeated biliary admissions, particularly cholecystitis, increase the risk of difficult ELLC, complications, prolonged stay, and readmissions.
- Individualized risk assessment and consent are crucial before ELLC.
- Strategies to minimize recurrent biliary admissions prior to cholecystectomy should be developed.
