Musbahi A, Abdulhannan P, Bhatti J, Dhar R, Rao M, Gopinath B. Outcomes and risk factors of cholecystectomy in high risk patients: A case series.
Ann Med Surg (Lond) 2020;
50:35-40. [PMID:
31956409 PMCID:
PMC6956681 DOI:
10.1016/j.amsu.2019.12.003]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 01/11/2023] Open
Abstract
Introduction
Many studies looked at outcomes and risk factors in laparoscopic cholecystectomies in general, including a few studies on risk factors and scoring systems in predicting conversion to open surgery. Little data has been produced on high-risk patients undergoing cholecystectomy. Identifying risk factors in this group could help stratify decision making regarding best management strategies.
The aim of this study was to investigate outcomes of laparoscopic cholecystectomies in patients with ASA 3 and 4.
Methods
Data was collected and collated from a prospectively maintained database of all laparoscopic cholecystectomies performed by 13 general surgeons in a single unit. Case notes were reviewed for all patients with ASA 3 and 4 between 2013 and 2017. Data analysis was performed using R studio v 3.4.
Results
244 cases were reviewed. Common bile duct was dilated in 52 cases (21.31%). Gall bladder wall was thick in 102 (41.8%) of the patients. Surgery was elective in 203 (83.2%) of the patients. ERCP was performed in 41 (16.9%) of the patients prior to surgery. 150 patients (62.2%) stayed for 1 day while 36 (14.9%) stayed for 2 days and the remaining 55 (22.9%) stayed for 3 days or more. Complications occurred in 37 (15.16%) of the patients while 23 (9.43%) of the patients were readmitted. 7 patients (2.87%) returned to theatre and 8 (3.28%) stayed in ITU post-op. Two patients died (0.82%).
Conclusion
Laparoscopic cholecystectomies in higher risk populations are safe. Alternative methods such as cholecystostomy and ERCP may be of benefit in these patients.
Gallstone disease represents a significant volume of elective and emergency work in the United Kingdom.
The primary aim of the study was to explore the factors that lead to complications in high risk patients (ASA 3-4).
Histological gallbladder thickness and emergency surgery were the factors most strongly associated with negative outcomes.
Age greater than 65 as an independent variable does not lead to an increase in negative outcomes.
Cholecystectomy is a relatively safe procedure in what is typically considered higher risk patients.
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