Contemporary Experience with Cholecystectomy: Establishing ‘Benchmarks’ Two Decades after the Introduction of Laparoscopic Cholecystectomy

Abstract

With quality and public reporting of increasing importance, benchmarks are anticipated to grow in relevance. We studied cholecystectomy in a practice in an urban tertiary care hospital. A total of 1083 cholecystectomies were performed in 2008 and 2009. Laparoscopic cholecystectomy was performed in 97.8 per cent of patients with a 2.2 per cent conversion rate. A planned open procedure was performed in only 2.2 per cent of patients. Approximately half of procedures were urgent and performed during an acute hospitalization. Most patients (74%) were female and most patients were overweight or obese (64.8%). Ages into the tenth decade of life were represented. Comorbidities included hypertension, 28.7 per cent; coronary disease, 15.6 per cent; diabetes mellitus, 13.4 per cent; gastroesophageal reflux disease, 10.7 per cent; and asthma, 5.5 per cent. Of female patients, 98 (12.2%) were postpartum and five (0.6%) were pregnant. Of 137 patients without gallstones, 59.1 per cent had biliary dyskinesia and 27 per cent had acalculous cholecystitis. Preoperative magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) were performed in most patients with suspected choledocholithiasis. Intraoperative cholangiograms were performed in 6.9 per cent of patients, 3.3 per cent for abnormal liver function studies. Postoperative ERCP was used in most patients with positive intraoperative cholangiograms. All-cause mortality was 0.8 per cent and attributable mortality was 0.2 per cent. Complications occurred in 7.5 per cent of patients, including retained common bile duct stones in 1.1 per cent, bile duct leak in 0.3 per cent, and common bile duct injury in 0.1 per cent.

Point-of-care biliary ultrasound in the emergency department (BUSED): implications for surgical referral and emergency department wait times

“… 1 Acute cholecystitis accounts for 3% to 11% of hospital admissions 2–4 and is associated with a mortality rate of 0.8%. 5 Point-of-care ultrasound (POCUS) in the emergency department has the potential to become an integral step to accelerate the diagnosis and management of gallbladder disease.…”

History, Physical Examination, Laboratory Testing, and Emergency Department Ultrasonography for the Diagnosis of Acute Cholecystitis

“…Many abdominal pain patients are found to have a benign etiology. However, the possibility of acute cholecystitis (AC), which accounts for 3%–11% of hospital admissions with a mortality rate of 0.8%, usually requires a comprehensive diagnostic evaluation using the modalities of history and physical examination (H&P), laboratory results, and imaging studies. Many studies have previously described individually the H&P, laboratory, and imaging consistent with AC.…”

Coronary Artery Disease and Gallbladder Inflammatory Pseudopolyps

“…The rarity of our case in which the occurrence of GIP is probably related to acalculous cholecystitis subsequent to acute coronary artery disease, is highlighted by the results of the brief literature search, without any restrictions on language and publication date, we conducted on Pubmed on the 4 January 2022. Indeed, using the keywords “(gallbladder inflammatory pseudopolyps) AND (coronary artery disease)” no records could be identified while applying the keywords “(acute acalculous cholecystitis) AND (coronary artery disease)” and “(acalculous cholecystitis) AND (inflammatory polyps)”, only 16 and one records were identified, respectively [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Three of the 16 records were excluded because they were not fully matching [ 25 , 26 , 27 ] and the single record deriving from the second search is not reported in Table 1 since it is a narrative review [ 28 ].…”

“…Indeed, using the keywords “(gallbladder inflammatory pseudopolyps) AND (coronary artery disease)” no records could be identified while applying the keywords “(acute acalculous cholecystitis) AND (coronary artery disease)” and “(acalculous cholecystitis) AND (inflammatory polyps)”, only 16 and one records were identified, respectively [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Three of the 16 records were excluded because they were not fully matching [ 25 , 26 , 27 ] and the single record deriving from the second search is not reported in Table 1 since it is a narrative review [ 28 ]. The records of the search are summarized in Table 1 .…”