Reliable risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy would optimize the clinical management.
Dr Urs Giger and colleagues from Switzerland determined risk factors that can be used for predicting perioperative complications.
The investigators analyzed risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy for acute and chronic cholecystitis.
The team used a stepwise logistic regression model using data from the Swiss Association of Laparoscopic and Thoracoscopic Surgery database.
A total of 22,953 patients with a mean age of 55 years, and a male-to-female ratio of 1:2 were identified.
|The surgeon's own clinical practice influences outcomes|
|Journal of the American College of Surgeons|
About 85% underwent elective, and 15% underwent emergency laparoscopic cholecystectomy.
The investigators showed that male gender, and duration of intervention were associated with an increased intraoperative local complication rate.
The team also identified that body weight, and the surgeon's own experience were independently associated with an increased intraoperative local complication rate.
In addition, male gender, age, and intraoperative complications were associated with a higher incidence of postoperative local complications.
Conversion to open surgery, American Society of Anesthesiologists risk score, body weight were also increased postoperative local complications.
The team found that emergency surgery, and duration of surgery were associated with a higher incidence of postoperative local complications.
Higher postoperative systemic complications were encountered with conversion, and the American Society of Anesthesiologists risk score.
The investigators noted that emergency surgery, and a prolonged intervention time increased postoperative systemic complications.
Dr Giger's team concludes , “For patients undergoing laparoscopic cholecystectomy, the risk of possible perioperative complications can be estimated based on patient characteristics, clinical findings, and the surgeon's own clinical practice.”
“So in the likelihood of a case being a ‘difficult cholecystectomy', an experienced surgeon should be involved both in the decision-making process, and during the operation.”
"If laparoscopic cholecystectomy lasts longer than 2 hours, the cumulative risk for perioperative complications is 4 times higher compared with an intervention that lasts between 30 and 60 minutes.”
“This is independent of the surgeon's personal skills with laparoscopic cholecystectomy.”