[Randomized trials and progress in surgery]

[Effectiveness of laparoscopic cholecystectomy for acute cholecystitis]

OBJECTIVE

To analyze the impact of laparoscopic cholecystectomy on in-hospital and postoperative mortality in patients with acute cholecystitis.

MATERIAL AND METHODS

Comparative analysis was based on primary statistical data presented in public available analytical collections «Surgical care in the Russian Federation» (Revishvili A.Sh. et al. 2019, 2020). Depending on introduction of laparoscopic surgery, all regions were divided into 4 groups. Between-group analysis of differences was carried out using χ2 test. Statistical processing was performed using SPSS Statistics software package for Windows.

RESULTS

According to 2-year follow-up data (2018, 2019), in-hospital mortality was 0.97 and 0.95% and postoperative mortality was 1.36 and 1.47%, respectively, in the regions with percentage of laparoscopic surgery for patients with acute cholecystitis was less than 25%. In the second group (percentage of laparoscopic surgery 25.01 - 50%), in-hospital mortality was 0.95 and 1.14%, postoperative mortality - 1.38 and 1.71%. In the third group (percentage of laparoscopic surgery 50.01 - 75%), in-hospital mortality was 0.92 and 0.99%, postoperative mortality - 1.27 and 1.38%. In the fourth group, percentage of laparoscopic surgery exceeded 75%. In-hospital mortality was 0.61 and 0.74%, postoperative mortality - 0.76 and 0.98%, respectively. Analysis of multi-field contingency tables revealed non-random between-group differences of in-hospital (p<0.001) and postoperative (p<0.001) mortality, as well as significant decrease of mortality following laparoscopic surgery. We also analyzed mortality after laparoscopic surgery considering technology maturity curve.

CONCLUSION

In-hospital and postoperative mortality in acute cholecystitis depend on availability of laparoscopic technologies.