Lights Off, Camera On! Laparoscopic Cholecystectomy Improves Outcomes in Cirrhotic Patients with Acute Cholecystitis

Author(s):
Tiago Finco; Xiaofei Zhang; Matthew Firek; Megan Brenner; Raul Coimbra

Background:

The clinical outcomes of acute cholecystitis (AC) in liver cirrhosis patients treated either by open (OC) or laparoscopic cholecystectomy (LC) have not been fully investigated in large patient populations to determine best practices, particularly in patients presenting with decompensated cirrhosis (DC).

Hypothesis:

In patients with AC, LC leads to better clinical outcomes when compared to OC, independent of severity of liver cirrhosis.

Methods:

The National Inpatient Sample (NIS) database was queried from 2012 to 2014 to identify AC patients which were stratified into three groups: no cirrhosis (NC), compensated cirrhosis (CC), and DC. Each group was classified according to the treatment: no cholecystectomy (NoC), OC, and LC. Demographic data and other baseline characteristics of each group were collected. Outcome measures included mortality, hospital length of stay (HLOS), cost, and surgical complications. Chi Square Analysis and ANOVA were used to compare categorical and continuous variables, respectively. Multiple logistic or linear regression analyses were performed to determine risk factors associated with outcomes. A p value of < 0.05 was considered significant.

Results:

A total of 273,499 AC patients were identified: 263,693 had NC, 4,652 had CC, and 5,154 had DC. LC was accompanied by significantly lower mortality than OC in both CC (1.0% versus 4.7%) and DC (5.0% versus 13.2%) patients. Similarly, HLOS was significantly shorter following LC in both CC (5.5 ± 5.1 versus 10.8 ± 14.8 days) and DC (9.7 ± 12.7 versus 16.7 ± 15.4 days) patients. Cost of LC was significantly lower than OC in both CC ($16,387 ± 13,456 versus $34,208 ± 39,887) and DC ($25,967 ± 29,702 versus $66,629 ± 78,570) patients. Compared with LC, logistic regression analyses revealed that both NoC and OC were risk factors associated with higher mortality (OR = 5.65 and 7.07, respectively). OC had a positive, while NoC had a negative correlation to total cost (coefficients of 15661 and -1519, respectively). Surgery related complications such as peritonitis, biliary tract disorder, and surgical infection had less or equal incidence in LC than OC regardless of the severity of cirrhosis.

Conclusions:

Cirrhotic patients with AC treated with LC had superior outcomes compared to OC regardless of the severity of cirrhosis. LC led to lower mortality, and decreased HLOS and cost. Our data confirms that LC is feasible and safe even in patients with decompensated liver cirrhosis.