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Recent trends in cholecystectomy in US veterans

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Abstract

Introduction

We hypothesize that the recent trend in performing cholecystectomy in US Veterans shows wide adoption of the laparoscopic technique and improvement in the outcome following both laparoscopic (LC) and open cholecystectomy (OC). This study utilizes the Veterans Affairs Surgical Quality Improvement Program database to examine the status and outcome of cholecystectomy.

Methods

A retrospective review of veterans who underwent cholecystectomy between 2008 and 2015 was performed. Data analysis included patient demographics, operations, and postoperative outcomes. Cochran-Armitage trend analysis was used to assess significant changes in outcome over the study period. p ≤ 0.05 was considered significant.

Results

A total of 40,722 patients (average age of 61 years) were included in the study (males 85.6%). LC was performed in the majority of patients (86.4%). Patients in the OC group (13.6%) were more likely to have advanced age (≥ 65 years) (47.6% vs 32.0%, p < 0.001) and higher ASA class (III-V) (81.9% vs 65.4%, p < 0.001) than those in the LC group. Compared with LC, OC had higher mortality rates at 30 days (1.3% vs 0.3%; OR = 1.6, p = 0.03), 3 months (2.6% vs 0.7%; OR = 1.7, p < 0.001), 6 months (3.9% vs 1.1%; OR = 1.5, p < 0.001) and 1 year (5.7% vs 2.0%; OR = 1.5, p < 0.001); higher rates of morbidity, including pneumonia (OR = 1.9, p < 0.001), deep venous thrombosis (OR = 2.4, p = 0.02), reoperation (OR = 1.8, p < 0.001), and superficial (OR = 4.9, p < 0.001) and deep (OR = 1.5, p = 0.01) surgical site infections; and a longer length of stay (6.5 days vs 2.6 days, p < 0.001). Trend analysis showed a significant decrease in both mortality (p = 0.02) and morbidity (p < 0.001) for LC over the study period, but no improvement in mortality (p = 0.35) and a only a minimal improvement in morbidity (p = 0.04) for OC.

Conclusion

In the recent era, LC has been widely performed in the VA with significant improvement in outcome. Efforts are needed to adopt alternative approaches to planned OC and to improve postoperative outcomes.

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Authors and Affiliations

  1. Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA

    Joshua Kong, Awni Shahait, Scott A. Gruber, Donald Weaver & Gamal Mostafa

  2. Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA

    Joshua Kong, Awni Shahait, Kara Girten, Mohanad Baldawi, Mustafa Rashad Hasnain, Khaled J. Saleh, Scott A. Gruber & Gamal Mostafa

Authors
  1. Joshua Kong
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  2. Awni Shahait
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  3. Kara Girten
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  4. Mohanad Baldawi
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  8. Donald Weaver
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Corresponding author

Correspondence to Gamal Mostafa.

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Disclosures

Joshua Kong, Awni Shahait, Kara Girten, Mohanad Baldawi, Mustafa Rashad Hasnain, Khaled J. Saleh, Scott A Gruber, Donald Weaver, and Gamal Mostafa have no conflicts of interest or financial ties to disclose.

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This work was accepted for podium presentation at the SAGES meeting in August 12-14, 2020, Cleveland, Ohio

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Kong, J., Shahait, A., Girten, K. et al. Recent trends in cholecystectomy in US veterans. Surg Endosc 35, 5558–5566 (2021). https://doi.org/10.1007/s00464-020-08056-8

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