Abstract
This paper assesses the risk of dying within 30 days of admission among 13,854 women who had a cholecystectomy performed as the principal operation from 1977 to 1981. The overall crude mortality rate was 1.2%. Women who had a simple elective cholecystectomy performed had a mortality rate similar to women who had a simple hysterectomy. The mortality was significantly higher than in the general female population (p < 0.05). Increased age, acute admission, admissions to hospital within 3 months prior to the index admission, the number of discharge diagnoses, and the geographical region were significantly associated with increased mortality. Exploration of the common bile duct was associated with higher mortality in the bivariate analysis, but the association disappeared when the number of discharge diagnoses was taken into account. Type of hospital and the population based cholecystectomy rate of the patient's residential area was not associated with mortality. As regards early mortality, it is concluded that simple elective cholecystectomy is a safe procedure before the age of 50 to 60 years. Acute admissions and more than one diagnosis at discharge were associated with an increased mortality, whereas exploration of the common bile duct may not be as important an independent factor as previously assumed.
Résumé
Le risque de mortalité à 30 jours a été évalué chez 13854 femmes opérées de cholécystectomie pendant la période 1977–1981. La mortalité globale a été de 1.2%. La mortalité des femmes ayant eu une simple cholécystectomie se rapprochait de celle des femmes ayant eu une hystérectomie. Cette mortalité a été significativement plus importante dans cette population que dans la population féminine en générale (p < 0.05). L'âge élevé, l'admission en urgence, à moins de trois mois d'une première admission, le nombre de diagnostics retenus à la sortie, et la région géographique (éloignée ou pas) étaient des facteurs significativement associés avec une mortalité plus élevée. En analyse bifactorielle, la mortalité était significativement plus élevée en cas d'exploration de la voie biliaire principale, mais cette signification disparaissait lorsqu'on a pris en compte le nombre de diagnostics à la sortie. Le type d'hôpital et le taux de cholécystectomie selon la région géographique n'ont pas influencé la mortalité. La cholécystecomie élective est une opération sure avant l'âge de 50–60 ans. L'admission en urgence et l'incertitude diagnostique au moment de la sortie sont associés avec une mortalité plus importante. Par contre, l'exploration de la voie biliaire principale n'est peut-être pas un facteur indépendent aussi important qu'il n'est classique de le dire.
Resumen
Este artículo presenta la evaluación de mortalidad ocurrida en los primeros treinta días después de la hospitalización en 13.854 mujeres sometidas a colecistectomía como operación principal en el período 1977–81. La tasa global cruda de mortalidad fue 1.2%. Las mujeres sometidas a colecistectomía electiva simple tuvieron una tasa de mortalidad similar a la de las mujeres sometidas a histectomía simple. La tasa de mortalidad fue significativamente mayor que en la población femenina general (p < 0.05). Factores asociados con mortalidad aumentada fueron la edad mayor, hospitalización aguda, hospitalización en los 3 meses anteriores a la fecha de hospitalización para colecistectomía, el número de diagnósticos de egreso y la región geográfica. La exploración del colédoco apareció asociada con una mortalidad mayor en el análisis bivariable, pero tal asociación desapareció cuando se tuvo en cuenta el número de disgnósticos de egreso. El tipo de hospital y la tasa de colecistectomía basada en la población del área de residencia del paciente no aparecieron correlacionados con la mortalidad. En relación con mortalidad temprana, se puede concluir que la colecistectomía electiva simple es un procedimiento seguro en pacientes menores de 50–60 años. Las hospitalizaciones agudas y un número de diagnósticos de egreso mayor de uno aparecieron asociados con mortalidad incrementada, en tanto que la exploración del colédoco puede no ser un factor independiente de importancia, tal como previamente se asumía.
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Bredesen, J., Jørgensen, T., Andersen, T.F. et al. Early postoperative mortality following cholecystectomy in the entire female population of Denmark, 1977–1981. World J. Surg. 16, 530–535 (1992). https://doi.org/10.1007/BF02104463
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DOI: https://doi.org/10.1007/BF02104463