Risk factors and outcomes of bailout procedures during laparoscopic cholecystectomy for acute cholecystitis: the
Marco Ceresoli1,2, Francesca Graziano3, Niccolò Allievi4
1School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. Marco.ceresoli@unimib.it.
Insights
Bailout procedures during laparoscopic cholecystectomy for acute cholecystitis occur in nearly 10% of cases, linked to inflammation and delayed surgery. These interventions increase postoperative complications and hospital stays.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Patient Outcomes
Background:
- Bailout procedures are critical during laparoscopic cholecystectomy to prevent complications.
- However, their real-world incidence, risk factors, and impact are not well-defined in large studies.
- This study investigates these aspects in acute cholecystitis cases.
Purpose of the Study:
- To determine the incidence of bailout procedures in laparoscopic cholecystectomy for acute cholecystitis.
- To identify predictors associated with the need for bailout procedures.
- To evaluate the clinical outcomes following bailout procedures.
Main Methods:
- A retrospective multicenter cohort study involving 1805 patients across 22 hospitals.
- Laparoscopic cholecystectomy for acute calculous cholecystitis was analyzed.
- Bailout procedures included open conversion or subtotal cholecystectomy; logistic regression identified predictors.
Main Results:
- Bailout procedures were performed in 9.8% of cases, most commonly open conversion (4.7%) or subtotal cholecystectomy (3.3%).
- Key predictors included intramural abscess, male sex, peritoneal collection, and delayed surgery (>7 days).
- Bailout was linked to longer hospital stays, higher severe complications, bile leaks, and readmissions.
Conclusions:
- Approximately 10% of laparoscopic cholecystectomies for acute cholecystitis require bailout procedures.
- These procedures are associated with advanced inflammation, delayed surgery, and increased postoperative morbidity.
- Optimizing surgical planning through early intervention and risk stratification is recommended.
Background:
Bailout procedures during laparoscopic cholecystectomy are employed to prevent major complications. However, their incidence, determinants, and clinical impact remain incompletely defined in large multicenter settings. This study aimed to assess the incidence of bailout procedures during laparoscopic cholecystectomy for acute cholecystitis, identify associated risk factors, and evaluate postoperative outcomes.
Methods:
A retrospective multicenter cohort study was conducted across 22 hospitals in Northern Italy, including consecutive adult patients undergoing laparoscopic cholecystectomy for acute calculous cholecystitis between January 2023 and December 2024. Bailout procedures were defined as any deviation from standard laparoscopic cholecystectomy, including subtotal cholecystectomy or conversion to open surgery. Multivariable logistic regression was used to identify independent predictors. Inter-center variability was assessed using the median odds ratio (MOR).
Results:
Among 1805 patients, bailout procedures were required in 176 cases (9.8%). The most common strategies were open conversion (4.7%) and laparoscopic subtotal cholecystectomy (3.3%). Failure to achieve the Critical View of Safety was the leading indication (54.2%). Independent predictors of bailout included intramural abscess (OR = 3.25), male sex (OR = 1.74), peritoneal collection (OR = 1.77), and surgical delay > 7 days (OR = 1.85). Significant inter-center variability was observed (MOR = 2.42). Bailout procedures were associated with worse outcomes, including longer hospital stay (11.8 vs. 6.7 days), higher severe complication rates (4.5 vs. 1.6%), increased bile leaks (10.8 vs. 2.3%), and higher readmission rates (6.8 vs. 2.3%).
Conclusions:
Bailout procedures are required in approximately 10% of LCs for AC and are strongly associated with markers of advanced inflammation and delayed surgery. Their use reflects both disease severity and institutional practice variability and is associated with increased postoperative morbidity. Early intervention and improved risk stratification may optimize surgical planning and outcomes.
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