Laparoscopic Cholecystectomy in the Acute Care Surgery Model: Risk Factors for Complications

Authors

Emily Fletcher
Erica Seabold
Ronald J. Markert, Wright State University - Main CampusFollow
Alyssa J. Gans, Wright State UniversityFollow
Akpofure Peter Ekeh, Wright State UniversityFollow

Document Type

Article

Publication Date

9-13-2019

Abstract

Background: The Acute Care Surgery (ACS) model developed during the last decade fuses critical care, trauma, and emergency general surgery. ACS teams commonly perform laparoscopic cholecystectomy (LC) for acute biliary disease. This study reviewed LCs performed by an ACS service focusing on risk factors for complications in the emergent setting. Methods: All patients who underwent LC on an ACS service during a 26-month period were identified. Demographic, perioperative, and complication data were collected and analyzed with Fisher's exact test, χ ² test, and Mann-Whitney U Test. Results: During the study period, 547 patients (70.2% female, mean age 46.1±18.1, mean body mass index 32.4±7.8 kg/m ² ) had LC performed for various acute indications. Mean surgery time was 77.9±50.2 minutes, and 5.7% of cases were performed "after hours." Rate of conversion to open procedure was 6%. Complications seen included minor bile leaks (3.8%), infection (3.8%), retained gallstones (1.1%), organ injury (1.1%), major duct injury (0.9%), and postoperative bleeding (0.9%). Statistical analysis demonstrated significant relationships between conversion, length of surgery, age, gender, and intraoperative cholangiogram with various complications. No significant relationships were detected between complications and BMI, pregnancy, attending experience, and time of operation. Discussion: Although several statistically significant relationships were identified between several risk factors and complications, these findings have limited clinical significance. Factors including attending years in practice and time of the operation were not associated with increased complications. ACS services are capable of performing a high volume of LCs for emergent indications with low complication and conversion rates.-Level of evidence:IV. Competing Interests: Competing interests: None declared.

Comments

This work is licensed under a Creative Commons Attribution-NonCommercial 2.0 Generic License.

Repository Citation

Fletcher, E., Seabold, E., Markert, R. J., Gans, A. J., & Ekeh, A. P. (2019). Laparoscopic Cholecystectomy in the Acute Care Surgery Model: Risk Factors for Complications. Trauma Surgery & Acute Care Open, 4 (1).
https://corescholar.libraries.wright.edu/surg/808

DOI

10.1136/tsaco-2019-000312

PMCID

PMC6744070