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Patient and surgeon factors contributing to bailout cholecystectomies: a single-institutional retrospective analysis

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Abstract

Background

Laparoscopic cholecystectomies continue to pose trouble for surgeons in the face of severe inflammation. In the advent of inability to perform an adequate dissection, a “bailout cholecystectomy” is advocated. Conversion to open or subtotal cholecystectomy is among the standard bailout procedures in such instances.

Methods

We performed a retrospective single institution review from January 2016 to August 2019. All patients who underwent a cholecystectomy were included, while those with a concurrent operation, malignancy, planned as an open cholecystectomy, or performed by a low volume surgeon were excluded. Patient characteristics, operative reports, and outcomes were collected, as were surgeon characteristics such as years of experience, case volume, and bailout rate. Univariable and multivariable analysis were performed.

Results

2458 (92.6%) underwent laparoscopic total cholecystectomy (LTC) and 196 (7.4%) underwent a bailout cholecystectomy (BOC). BOC patients tended to be older (p < 0.001), male (p < 0.001), have a longer duration of symptoms (p < 0.001), and higher ASA class (p < 0.001). They also had more signs of biliary inflammation, as evidenced by increased leukocytosis (p < 0.001), tachycardia (p < 0.001), bilirubinemia (p = 0.003), common bile duct dilation (p < 0.001), and gallbladder wall thickening (p < 0.001). The BOC cohort also had increased rates of complications, including bile leak (16%, p < 0.001), retained stone (5.1%, p = 0.005), operative time (114 min vs 79 min, p < 0.001), and secondary interventions (22.7%, p < 0.001). Male gender (aOR = 2.8, p < 0.001), preoperative diagnosis of acute cholecystitis (aOR = 2.2, p = 0.032), right upper quadrant tenderness (aOR = 3.0, p = 0.008), Asian race (aOR = 2.7, p = 0.014), and intraoperative adhesions (aOR = 13.0, p < 0.001) were found to carry independent risk for BOC. Surgeon bailout rate ≥ 7% was also found to be an independent risk factor for conversion to BOC.

Conclusions

Male gender, signs of biliary inflammation (tachycardia, leukocytosis, dilated CBD, and diagnosis of acute cholecystitis), as well as surgeon bailout rate of 7% were independent risk factors for BOC.

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Acknowledgements

Ken Hine MD, Timothy Park MD, and Eduardo Morales-Vicente MD assisted in data collection and chart review.

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Authors and Affiliations

  1. NewYork-Presbyterian/Queens, 56-45 Main St., Flushing, NY, 11355, USA

    Miya C. Yoshida, Takuya Ogami, Eileen X. Bui, Shahenda Khedr & Chun-Cheng Chen

  2. Weill Cornell Medicine, New York, USA

    Kaylee Ho & Chun-Cheng Chen

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  1. Miya C. Yoshida
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Correspondence to Miya C. Yoshida.

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Miya C. Yoshida, Takuya Ogami, Kaylee Ho, Eileen X. Bui, Shahenda Khedr, and Chun-Cheng Chen have no conflict of interest.

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Yoshida, M.C., Ogami, T., Ho, K. et al. Patient and surgeon factors contributing to bailout cholecystectomies: a single-institutional retrospective analysis. Surg Endosc 36, 6696–6704 (2022). https://doi.org/10.1007/s00464-021-08942-9

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