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Morbidity following emergency and elective cholecystectomy: a retrospective comparative cohort study

INTRODUCTION: An emergency laparoscopic cholecystectomy (EMLC) is commonly performed for all biliary pathology, yet EMLC can be challenging due to acute inflammation. Understanding the risks of EMLC is necessary before patients can make an informed decision regarding operative management. The aim of...

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Autores principales: Lucocq, James, Radhakishnan, Ganesh, Scollay, John, Patil, Pradeep
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9613569/
https://www.ncbi.nlm.nih.gov/pubmed/35201423
http://dx.doi.org/10.1007/s00464-022-09103-2
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author Lucocq, James
Radhakishnan, Ganesh
Scollay, John
Patil, Pradeep
author_facet Lucocq, James
Radhakishnan, Ganesh
Scollay, John
Patil, Pradeep
author_sort Lucocq, James
collection PubMed
description INTRODUCTION: An emergency laparoscopic cholecystectomy (EMLC) is commonly performed for all biliary pathology, yet EMLC can be challenging due to acute inflammation. Understanding the risks of EMLC is necessary before patients can make an informed decision regarding operative management. The aim of the present study was to compare rates of operative and post-operative outcomes between EMLC and elective LC (ELLC) using a large contemporary cohort, to inform the consent process and influence surgical decision making. METHODS: All patients who underwent EMLC and ELLC in one UK health board between January 2015 and December 2019 were considered for inclusion. Data were collected retrospectively from multiple regional databases using a deterministic records-linkage methodology. Patients were followed up for 100 days post-operatively for adverse outcomes and outcomes were compared between groups using both univariate and multivariate analysis adjusting for pre-operative factors. RESULTS: A total of 2768 LCs were performed [age (range), 52(13–92); M:F, 1:2.7]. In both the univariate and multivariate analysis, EMLC was positively associated with subtotal cholecystectomy (RR 2.0; p < 0.001), post-operative complication (RR 2.8; p < 0.001), post-operative imaging (RR 2.0; p < 0.001), post-operative intervention (RR 2.3; p < 0.001), prolonged post-operative hospitalisation (RR 3.8; p < 0.001) and readmission (RR 2.2; p < 0.001). EMLC had higher rates of post-operative mortality in univariate analysis (RR 10.8; p = 0.01). DISCUSSION: EMLC is positively associated with adverse outcomes versus ELLC. Of course this study does not focus on a specific biliary pathology; nevertheless, it illustrates the additional risk associated with EMLC. This should be clearly outlined during the consent process but should be balanced with the risk of further biliary attacks. Further studies are required to identify particular patient groups who benefit from elective surgery.
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spelling pubmed-96135692022-10-29 Morbidity following emergency and elective cholecystectomy: a retrospective comparative cohort study Lucocq, James Radhakishnan, Ganesh Scollay, John Patil, Pradeep Surg Endosc 2021 SAGES Oral INTRODUCTION: An emergency laparoscopic cholecystectomy (EMLC) is commonly performed for all biliary pathology, yet EMLC can be challenging due to acute inflammation. Understanding the risks of EMLC is necessary before patients can make an informed decision regarding operative management. The aim of the present study was to compare rates of operative and post-operative outcomes between EMLC and elective LC (ELLC) using a large contemporary cohort, to inform the consent process and influence surgical decision making. METHODS: All patients who underwent EMLC and ELLC in one UK health board between January 2015 and December 2019 were considered for inclusion. Data were collected retrospectively from multiple regional databases using a deterministic records-linkage methodology. Patients were followed up for 100 days post-operatively for adverse outcomes and outcomes were compared between groups using both univariate and multivariate analysis adjusting for pre-operative factors. RESULTS: A total of 2768 LCs were performed [age (range), 52(13–92); M:F, 1:2.7]. In both the univariate and multivariate analysis, EMLC was positively associated with subtotal cholecystectomy (RR 2.0; p < 0.001), post-operative complication (RR 2.8; p < 0.001), post-operative imaging (RR 2.0; p < 0.001), post-operative intervention (RR 2.3; p < 0.001), prolonged post-operative hospitalisation (RR 3.8; p < 0.001) and readmission (RR 2.2; p < 0.001). EMLC had higher rates of post-operative mortality in univariate analysis (RR 10.8; p = 0.01). DISCUSSION: EMLC is positively associated with adverse outcomes versus ELLC. Of course this study does not focus on a specific biliary pathology; nevertheless, it illustrates the additional risk associated with EMLC. This should be clearly outlined during the consent process but should be balanced with the risk of further biliary attacks. Further studies are required to identify particular patient groups who benefit from elective surgery. Springer US 2022-02-24 2022 /pmc/articles/PMC9613569/ /pubmed/35201423 http://dx.doi.org/10.1007/s00464-022-09103-2 Text en © Crown 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle 2021 SAGES Oral
Lucocq, James
Radhakishnan, Ganesh
Scollay, John
Patil, Pradeep
Morbidity following emergency and elective cholecystectomy: a retrospective comparative cohort study
title Morbidity following emergency and elective cholecystectomy: a retrospective comparative cohort study
title_full Morbidity following emergency and elective cholecystectomy: a retrospective comparative cohort study
title_fullStr Morbidity following emergency and elective cholecystectomy: a retrospective comparative cohort study
title_full_unstemmed Morbidity following emergency and elective cholecystectomy: a retrospective comparative cohort study
title_short Morbidity following emergency and elective cholecystectomy: a retrospective comparative cohort study
title_sort morbidity following emergency and elective cholecystectomy: a retrospective comparative cohort study
topic 2021 SAGES Oral
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9613569/
https://www.ncbi.nlm.nih.gov/pubmed/35201423
http://dx.doi.org/10.1007/s00464-022-09103-2
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