Open cholecystectomy: its morbidity and mortality as a reference standard

In a retrospective study of 10,471 cholecystectomies, performed between 1971 and 1990, the incidence and causes of death and morbidity of cholecystectomy were analysed. There were 47 postoperative deaths (0.4%); 6 deaths occurred in 5841 patients less than 50 years old, 23 in 3898 patients between 50 and 70 years old and 18 in 732 patients more than 70 years old. Death rates in each group were, respectively, 0.1%, 0.6% and 2.5% (p < 0.001). The death rate in 9339 patients who had cholecystectomy alone was 0.3% and the death rate in 1132 patients who had a concomitant common bile duct exploration (CBDE) was 1.6% (p < 0.001). Cardiovascular complications were the main cause of death, and biliary, pulmonary and wound complications were the most common. There were 614 complications in 529 patients; 176 of these patients were less than 50 years old, 252 were between 50 and 70 years old and 101 were more than 70 years old. Complication rates were, respectively, 3.0%, 6.5% and 13.8% (p < 0.001). For patients with cholecystectomy alone the morbidity was 3.6% and for patients who had a concomitant CBDE the morbidity was 17% (p < 0.001). The mortality and morbidity of cholecystectomy increase significantly with age and a concomitant CBDE. However, patients who underwent cholecystectomy electively or for acute cholecystitis had comparable mortality and morbidity.