A 20-Year Analysis of Risk Factors for Complicated Postoperative Course Following Laparoscopic Cholecystectomy

BackgroundCholecystectomy is the most common surgical intervention performed in the United States with over 300,000 annual cases. We aim to describe risk factors for complications and prolonged stay after cholecystectomy in a 20-year analysis of a national database.MethodsThe Nationwide Inpatient Sample (NIS) was queried for years 2000-2019 for patients who underwent cholecystectomy within 7 days of admission. Complicated stay was defined as postoperative stay longer than 3 days or an ICU admission. Outcomes were postoperative complications, hospital length of stay, hospital charges, and mortality.ResultsThere were 901,205 patients who underwent laparoscopic cholecystectomy. Mean age was 50 ± 19 years, 68% were female. Complicated stay was identified in 13% of patients. These patients were older (61 ± 19 vs 49 ± 19), more likely to be male (47% vs 32%), and to have Medicare insurance (51% vs 26%). Acute presentation as indication for surgery (acute cholecystitis, choledocholithiasis, and pancreatitis) were more common in complicated stays compared to chronic cholecystitis or cholelithiasis only. They were more likely to undergo subtotal cholecystectomy (1.2% vs 0.54%) or conversion to open surgery (0.98% vs 0.08%), to suffer common bile duct injury (0.54% vs 0.04%), and have higher mortality (2.4% vs 0.06%). On multivariate regression, the strongest predictors for complicated stay were CBDI (OR 12.9), conversion to open (OR 11.4), and subtotal cholecystectomy (OR 1.8).ConclusionOpen or subtotal cholecystectomy, older age, pancreatitis, and delayed operation from admission were associated with complicated course. This data highlights careful preoperative risk stratification and early operative intervention to reduce complications.