Gallbladder wall thickness adversely impacts the surgical outcome

BACKGROUNDS/AIMS: To evaluate surgical outcomes of patients with gallbladder wall thickness (GBWT) > 5 mm. METHODS: Patients who underwent cholecystectomy were classified into two groups according to their GBWT status (GBWT+ vs. GBWT–). RESULTS: Among 1,211 patients who underwent cholecystectomy, GBWT+ was seen in 177 (14.6%). The GBWT+ group was significantly older with more males, higher ASA score, higher alkaline phosphatase level, higher international normalized ratio, and lower albumin level than the GBWT– group. On ultrasound, GBWT+ patients had larger stone size, more pericholecystic fluid, more common bile duct stone, and more biliary pancreatitis. Compared with the GBWT– group, the GBWT+ group had more urgent surgeries (12.4% vs. 3.2%, p = 0.001), higher conversion rate (4.5% vs. 0.3%, p = 0.001), prolonged operative time (67 ± 38 vs. 54 ± 29 min; p = 0.001), more bleeding (3.4% vs. 0.5%, p = 0.002), and more need of drain (21.5% vs. 10.5%, p = 0.001). By multivariate analysis, factors associated with increased length of hospital stay were GBWT+ (HR: 1.97, 95% CI: 1.19–3.25, p = 0.008), urgent surgery (HR: 10.2, 95% CI: 4.07–25.92, p = 0.001), prolonged surgery (HR: 1.01, 95% CI: 1.0–1.02, p = 0.001), and postoperative drain (HR: 11.3, 95% CI: 6.40–20.0, p = 0.001). CONCLUSIONS: Variables such as GBWT ≥ 5 mm, urgent prolonged operation, and postoperative drains are independent predictors of extended hospital stay. GBWT+ patients are twice likely to stay in hospital for more than 72 hours and more prone to develop complications than GBWT– patients.