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Cholecystectomy in patients with cirrhosis: a population-based cohort study from England

Lookup NU author(s): John Hammond

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Abstract

© 2022 International Hepato-Pancreato-Biliary Association Inc.Background: This population-based cohort study aimed to determine postoperative outcomes after emergency and elective cholecystectomy in patients with cirrhosis. Methods: Linked electronic healthcare data from England were used to identify all patients undergoing cholecystectomy between January 2000 and December 2017. Length of stay (LOS), re-admission, case fatality and the odds ratio of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex and co-morbidity using logistic regression. Results: Of the total 69,141 eligible patients who underwent a cholecystectomy, 511 (0.74%) had cirrhosis. In patients without cirrhosis 86.55% underwent a laparoscopic procedure compared with 57.53% in patients with cirrhosis (p < 0.0001). LOS was longer in those with cirrhosis (3 IQR 1–8 vs 1 IQR 1–3 days,p < 0.0001). 90-day re-admission was greater in patients with cirrhosis, 36.79% compared with 14.95% in those without cirrhosis. 90-day case fatality after elective cholecystectomy in patients with and without cirrhosis was 2.79% and 0.43%; and 12.82% and 2.39% following emergency cholecystectomy. This equated to a 3-fold (OR 3.22, IQR 1.72–6.02) and a 4-fold (OR 4.52, IQR 2.46–8.33) increased odds of death at 90-days following elective and emergency cholecystectomy after adjusting for confounders. Conclusion: Patients with cirrhosis undergoing cholecystectomy have an increased 90-day risk of postoperative mortality, which is significantly worse after emergency procedures.

Publication metadata

Author(s): Adiamah A, Crooks CJ, Hammond JS, Jepsen P, West J, Humes DJ

Publication type: Article

Publication status: Published

Journal: HPB

Year: 2023

Volume: 25

Issue: 2

Pages: 189-197

Print publication date: 01/02/2023

Online publication date: 20/08/2022

Acceptance date: 15/08/2022

ISSN (print): 1365-182X

ISSN (electronic): 1477-2574

Publisher: Elsevier B.V.

URL: https://doi.org/10.1016/j.hpb.2022.08.006

DOI: 10.1016/j.hpb.2022.08.006

PubMed id: 36435712

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