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Cholecystectomy Concomitant with Laparoscopic Gastric Bypass: A Trend Analysis of the Nationwide Inpatient Sample from 2001 to 2008

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Abstract

Background

Gallstone formation is common in obese patients, particularly during rapid weight loss. Whether a concomitant cholecystectomy should be performed during laparoscopic gastric bypass surgery is still contentious. We aimed to analyze trends in concomitant cholecystectomy and laparoscopic gastric bypass surgery (2001–2008), to identify factors associated with concomitant cholecystectomy, and to compare short-term outcomes after laparoscopic gastric bypass with and without concomitant cholecystectomy.

Methods

We used data from adults undergoing laparoscopic gastric bypass for obesity from the Nationwide Inpatient Sample. The Cochran–Armitage trend test was used to assess changes over time. Unadjusted and risk-adjusted generalized linear models were performed to assess predictors of concomitant cholecystectomy and to assess postoperative short-term outcomes.

Results

A total of 70,287 patients were included: mean age was 43.1 years and 81.6% were female. Concomitant cholecystectomy was performed in 6,402 (9.1%) patients. The proportion of patients undergoing concomitant cholecystectomy decreased significantly from 26.3% in 2001 to 3.7% in 2008 (p for trend < 0.001). Patients who underwent concomitant cholecystectomy had higher rates of mortality (unadjusted odds ratios [OR], 2.16; p = 0.012), overall postoperative complications (risk-adjusted OR, 1.59; p = 0.001), and reinterventions (risk-adjusted OR, 3.83; p < 0.001), less frequent routine discharge (risk-adjusted OR, 0.70; p = 0.05), and longer adjusted hospital stay (median difference, 0.4 days; p < 0.001).

Conclusions

Concomitant cholecystectomy and laparoscopic gastric bypass surgery have decreased significantly over the last decade. Given the higher rates of postoperative complications, reinterventions, mortality, as well as longer hospital stay, concomitant cholecystectomy should only be considered in patients with symptomatic gallbladder disease.

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Acknowledgment

The authors acknowledge the Team “Research on Research” for the templates for writing the introduction and discussion sections of the manuscript [37] and the templates for literature review [38].

Financial Disclosure/Funding Support

This work was supported by grant PBBEP3-131567 from the Swiss National Science Foundation (MW). The authors have no other potential conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

Conflicts of Interest

All contributing authors, including Mathias Worni, Ulrich Guller, Anand Shah, Mihir Gandhi, Jatin Shah, Dimple Rajgor, Ricardo Pietrobon, Danny O. Jacobs, and Truls Østbye, declare that they have no conflicts of interest in relation to this manuscript.

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Authors and Affiliations

  1. Research on Research Group, Department of Surgery, Duke University Medical Center, DUMC 3094, Durham, NC, 27710, USA

    Mathias Worni, Anand Shah, Mihir Gandhi, Jatin Shah, Dimple Rajgor & Ricardo Pietrobon

  2. Department of Visceral Surgery and Medicine, University of Bern, Bern, Switzerland

    Mathias Worni & Ulrich Guller

  3. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Danny O. Jacobs

  4. Singapore Clinical Research Institute, Singapore, Singapore

    Mihir Gandhi

  5. Duke-NUS Graduate Medical School, Singapore, Singapore

    Mihir Gandhi & Truls Østbye

  6. Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA

    Truls Østbye

  7. Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Ulrich Guller

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  1. Mathias Worni
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  9. Truls Østbye
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Correspondence to Mathias Worni.

Appendix

Appendix

Table 5 Intraoperative and postoperative complications as well as reinterventions identified through ICD-9-CM codes
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Worni, M., Guller, U., Shah, A. et al. Cholecystectomy Concomitant with Laparoscopic Gastric Bypass: A Trend Analysis of the Nationwide Inpatient Sample from 2001 to 2008. OBES SURG 22, 220–229 (2012). https://doi.org/10.1007/s11695-011-0575-y

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  • DOI: https://doi.org/10.1007/s11695-011-0575-y

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