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Cholecystectomy in patients with cirrhosis: a population-based cohort study from England

  • Alfred Adiamah
    Correspondence
    Correspondence: A. Adiamah, Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
    Affiliations
    National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
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  • Colin J. Crooks
    Affiliations
    National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK

    Division of Hepatobiliary and Transplant Surgery, Freeman Hospital. Freeman Rd, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK
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  • John S. Hammond
    Affiliations
    Division of Hepatobiliary and Transplant Surgery, Freeman Hospital. Freeman Rd, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK
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  • Peter Jepsen
    Affiliations
    Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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  • Joe West
    Affiliations
    Population and Lifespan Sciences, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK
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  • David J. Humes
    Affiliations
    National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK

    Population and Lifespan Sciences, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK
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Published:August 20, 2022DOI:https://doi.org/10.1016/j.hpb.2022.08.006

      Abstract

      Background

      This population-based cohort study aimed to determine postoperative outcomes after emergency and elective cholecystectomy in patients with cirrhosis.

      Methods

      Linked electronic healthcare data from England were used to identify all patients undergoing cholecystectomy between January 2000 and December 2017. Length of stay (LOS), re-admission, case fatality and the odds ratio of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex and co-morbidity using logistic regression.

      Results

      Of the total 69,141 eligible patients who underwent a cholecystectomy, 511 (0.74%) had cirrhosis. In patients without cirrhosis 86.55% underwent a laparoscopic procedure compared with 57.53% in patients with cirrhosis (p < 0.0001). LOS was longer in those with cirrhosis (3 IQR 1–8 vs 1 IQR 1–3 days,p < 0.0001). 90-day re-admission was greater in patients with cirrhosis, 36.79% compared with 14.95% in those without cirrhosis. 90-day case fatality after elective cholecystectomy in patients with and without cirrhosis was 2.79% and 0.43%; and 12.82% and 2.39% following emergency cholecystectomy. This equated to a 3-fold (OR 3.22, IQR 1.72–6.02) and a 4-fold (OR 4.52, IQR 2.46–8.33) increased odds of death at 90-days following elective and emergency cholecystectomy after adjusting for confounders.

      Conclusion

      Patients with cirrhosis undergoing cholecystectomy have an increased 90-day risk of postoperative mortality, which is significantly worse after emergency procedures.
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