Early cholecystectomy for cholecystitis in patients with severe comorbidity

This study aimed to investigate peri- and postoperative complications in severely comorbid patients undergoing early surgery for cholecystitis.

Data for 32,463 patients who had emergency surgery for cholecystitis from the Swedish Cholecystectomy Registry, National Patient Register, National Prescribed Drug Register and the National Cause of Death Register were used. The odds ratios (OR) for complications were calculated using logistic regression. Specific postoperative complications were assessed for severely comorbid (ASA3) versus healthy (ASA1-2) patients.

It was more common with perioperative (OR 1.24, 95 % confidence interval 1.04-1.48) and postoperative complications (OR 1.21, 95 % confidence interval 1.13-1.3) in ASA3 than ASA1-2. The OR for postoperative complications in ASA3 remained stable in subgroup analyses of age >70, >5 days wait time and laparoscopic surgery. The OR for postoperative complications in ASA3 patients undergoing open surgery was 1.12 (95 % confidence interval 0.96-1.32). The complications that increased most in severely comorbid patients were bile leakage, bleeding and infection. The OR for severe complications (requiring intervention or ICU admission) was 1.69 (95 % confidence interval 1.47-1.94) in ASA3 versus ASA1-2.

ASA3 patients had an increased risk of postoperative complications. Better perioperative care may reduce the risk for these patients.