Comparative Registry-Based Analysis of Cholecystectomy Outcomes at a German University Hospital and Nationwide Data

Laparoscopic cholecystectomy is one of the most common procedures in general surgery and is the gold standard of care for symptomatic cholecystolithiasis, as well as for cholecystitis. The aim of this study was to analyze the surgical approach and outcomes of cholecystectomy (CE) at a university hospital and compare the findings with published national data.

We conducted a retrospective study including all patients who underwent CE between January 2008 and December 2017 at our center. Logistic regression analysis was used to evaluate risk factors for conversion. Surgical management and complications were compared with published nationwide annual reports.

Of the 1,537 CEs, 881 (57.4%) were elective procedures, and 656 (42.7%) were emergency procedures. A total of 1,261 (82.2%) patients underwent minimally invasive surgery, and conversion was necessary in 10.7% (n = 135) of patients. Multivariate regression analysis revealed that preoperative biliary intervention (p < 0.001), previous abdominal surgery (p = 0.002), and male sex (p = 0.011) were independent risk factors for conversion. Compared to the German Institute for Quality Assurance and Transparency in Healthcare (AQUA Institute), we found higher rates for primary open surgery (17.9% vs. 5.0-6.8%), conversion rates (10.7% vs. 4.1-4.7%), postoperative complications (7.8% vs. 2.0-2.1%), and reinterventions (4.3% vs. 2.0-2.6%). However, our patients had significantly higher Anesthesiologists (ASA) scores (ASA III: 38.6% vs. 22.6-22.8%; ASA IV: 6.3% vs. 1.9%), more frequent preoperative biliary interventions (17.6% vs. 7.6-8.6%), and acute cholecystitis (65.6% vs. 33.8-37.2%). Mortality (1.3% vs. 0.9-1.0%) and the mean length of hospital stay (6.4 days vs. 4.7-5.2 days) did not differ significantly.

Our data show that CE at a university hospital can be performed with comparable mortality rates and lengths of stay in patients with more comorbidities. Our results emphasize the need for patient-tailored management in high-risk patients.