Sex-based analysis of the outcome of laparoscopic cholecystectomy for acute cholecystitis.
ABSTRACT Complicated acute cholecystitis, for example when empyema or gangrene is present, is associated with increased postoperative morbidity and mortality rates. The aim of this study was to determine the correlation between sex, the severity of acute cholecystitis and the outcome of laparoscopic cholecystectomy.
Of 674 patients in whom laparoscopic cholecystectomy was attempted, 348 had chronic cholecystitis and 326 had acute cholecystitis. The medical records of the latter were reviewed retrospectively.
The proportion of male patients significantly increased with the severity of cholecystitis: 37.4 per cent of those with chronic cholecystitis were men, compared with 44.4 per cent of those with uncomplicated acute cholecystitis and 57 per cent of those with complicated acute cholecystitis (P = 0.001). Multivariate analysis showed that advanced age (odds ratio 2.24; P = 0.004) and male sex (odds ratio 1.76; P = 0.029) independently predicted complicated acute cholecystitis. The conversion rate to open operation was 6.4 per cent in men and 5.9 per cent in women (P = 0.843). The postoperative complication rate was 10.3 and 8.2 per cent respectively (P = 0.528).
Male sex was identified as a risk factor for more severe acute cholecystitis, but outcome for men after laparoscopic cholecystectomy was not significantly different from that for women.
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ABSTRACT: Resumen La colecistectomía laparoscópica ha sido aceptada como el méto-do de elección para el tratamiento de las patologías quirúrgicas de la vesícula biliar. Sin embargo, a pesar de que es considerada como un procedimiento laparoscópico básico, en ocasiones debe conver-tirse a un procedimiento abierto. Pacientes y métodos: Se estudiaron 1,843 pacientes sometidos a colecistectomía laparoscópica del 1 de enero, 1999 al 31 de di-ciembre, 2003 en el Hospital ABC, utilizando el expediente médico electrónico. Resultados: Fueron 1,150 mujeres (62.39%) y 691 hombres (37.56%), con una edad promedio de 49 años. Cuatrocientos ochenta pacientes fueron intervenidos de urgencia (26.07%) y 1,361 de for-ma electiva (73.92%). Hubo 42 complicaciones (2.28%). Las más frecuentes fueron: sangrado del lecho vesicular y sangrado de al-gún puerto. Se convirtieron 51 casos (2.7%) y en sólo doce de ellos la causa fue una complicación (23.52%). En los 39 casos restantes la principal causa de conversión fue la presencia de adherencias e imposibilidad para identificar las estructuras anatómicas. La edad promedio en este grupo de pacientes fue de 58 años. Cuarenta casos fueron intervenidos de forma electiva (78.47%) y once pa-cientes de urgencia (21.56%). En ambas, la causa más frecuente de conversión fueron las adherencias y la imposibilidad para identi-ficar la anatomía. El tiempo de estancia intrahospitalaria promedio fue de 6 días. El tiempo quirúrgico promedio fue de 197 minutos. El índice de masa corporal en este grupo de pacientes fue de 26.72 kg/m 2 (13.39 a 42.27 kg/m 2). Cincuenta por ciento de este grupo de pacientes presentaban cole-cistitis aguda, el 30% colecistitis crónica y los restantes otras con-diciones como síndrome de Mirizzi, coledocolitiasis, etc. La única variable que se relaciona con un riesgo elevado de conversión es la edad (p = 0.01; OR = 1.30). Las diferencias de los días de estancia Abstract Laparoscopic cholecystectomy has been accepted as the treatment of choice for the surgical pathologies of the gallbladder. It is consid-ered a basic laparoscopic procedure, nevertheless it has to be con-verted to an open procedure occasionally. Patients and methods: We studied 1,841 patients who underwent laparoscopic cholecytstectomy at the ABC Medical Center, from January 1, 1999 to December 31, 2003. We used the Medical Elec-tronic File System. Results: There were 1,150 women (62.39%) and 691 men (37.56%) with a mean age of 49 years. Four hundred and eighty patients underwent emergency procedures (26.07%) and 1,316 were operated on electively (73.92%). There were 42 complica-tions (2.28%), the most frequent were hemorrhage of the gall-bladder bed and bleeding of a laparoscopic port. Fifty-one cas-es were converted to an open procedure (2.7%), only twelve of them due to a complication (23.52%). In the remaining 38 cases the conversion was due to the presence of adhesions and tech-nical difficulties. The mean age in this group was 58 years. For-ty patients underwent elective surgery (78.47%) and eleven un-derwent emergency procedures (21.56%). The mean hospital stay was 6 days for this group of patients and the average sur-gical time was 197 minutes. The body mass index in this group of patients was 26.72 kg/m 2 (13.39 a 42.27 kg/m 2). Fifty percent of these patients presented with acute cholecystitis, 30% chronic cholecystitis and the rest had associated conditions such as Mirizzi's syndrome, choledocholithiasis, etc. The only variable related to an elevated conversion risk was the age (p = 0.01; OR = 1.30). The difference between the in-hospital stay (2.2 vs 6 days) and the difference in the surgical time were also statis-tically significant (p = 0.003 [OR = 1.11] and p = 0.000 [OR = 1.01]), respectively.
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ABSTRACT: During the reproductive years, women have a 4-fold higher prevalence of gallstones than men, making gallbladder disease a critically important topic in women's health. Among age-matched women and men hospitalized for cholecystitis, gender based differences in demographics, management, and economic and clinical outcomes were identified. A cross-sectional study was conducted using the Nationwide Inpatient Sample. Outcomes were mortality, complications, length of stay, and cost. Women accounted for 65% of admissions for cholecystitis, with women more likely to have shorter time to surgery (1.6 vs 1.9 days) and laparoscopy (86 vs 76%) (P < .05). After cholecystectomy, women had lower mortality (.6% vs 1.1%), fewer complications (16.9 vs 24.1), shorter lengths of stay (4.2 vs 5.4 days), and lower costs ($10,556 vs $13,201) (P < .05). On multivariate analysis of age-matched patients, women had lower odds of mortality (odds ratio [OR], .75), complications (OR, .86), length of stay (OR, .95), and cost (OR, .93). Longer time to surgery and open cholecystectomy were independent predictors of worse outcomes. In cholecystitis and cholecystectomy, women have better clinical and economic outcomes then age-matched men.American journal of surgery 09/2013; · 2.36 Impact Factor
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ABSTRACT: Obesity has historically been a positive predictor of surgical morbidity, especially in the morbidly obese. The purpose of our study was to compare outcomes of obese patients undergoing laparoscopic cholecystectomy (LC). We reviewed 1382 consecutive patients retrospectively who underwent LC for various pathologies from January 2008 to August 2011. Patients were stratified based on the World Health Organization definitions of obesity: nonobese (body mass index [BMI] < 30 kg/m(2)), obesity class I (BMI 30-34.9 kg/m(2)), obesity class II (BMI 35-39.9 kg/m(2)), and obesity class III (BMI ≥ 40 kg/m(2)). The primary end points were conversion rates and surgical morbidity. The secondary end point was length of stay. There were significantly more females in the obesity II and III groups (P = 0.0002). American Society of Anesthesiologists scores were significantly higher in the obesity I, II, and III groups compared with the nonobese (P < 0.05; P < 0.01; and P < 0.0001, respectively). Independent predictors of conversion on multivariate analysis (MVA) included age (P = 0.01), acute cholecystitis (P = 0.03), operative time (P < 0.0001), blood loss (P < 0.0001), and fellowship-trained surgeons (P < 0.0001). Independent predictors of intraoperative complications on MVA included age (P = 0.009), white patients (P = 0.009), previous surgery (P = 0.001), operative time (P < 0.0001), and blood loss (P = 0.01). Independent predictors of postoperative complications on MVA included American Society of Anesthesiologists score (P < 0.0001), acute cholecystitis (P < 0.0001), and a postoperative complication (P < 0.0001). BMI was not a predictor of conversions or surgical morbidity. Length of stay was not significantly different between the four groups. This study demonstrates that overall conversion rates and surgical morbidity are relatively low following LC, even in obese and morbidly obese patients.Journal of Surgical Research 02/2014; · 2.12 Impact Factor