Outcomes and risk factors of cholecystectomy in high risk patients: A case series

Musbahi, Aya; Abdulhannan, Peshang; Bhatti, Junaid; Dhar, Rajat; Mv, Rao; Gopinath, Bussa

doi:10.1016/j.amsu.2019.12.003

Cited by 9 publications

(9 citation statements)

References 14 publications

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“…(p=0.003). Table (7) showed statistically significant relation between observations and level of CLOC risk scoring. There was actual conversion according to groups with 'high risk scoring >7 and conversions in the' low risk >6 easy' group below.…”

Section: Resultsmentioning

confidence: 87%

See 1 more Smart Citation

A Prospective Study of the Incidence of Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy in 100 Patients

Grace¹,

Kamel

Rafik

et al. 2021

Ain Shams Medical Journal

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Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstones. Conversion to an open procedure is necessary in 5-10% of patients.The aim of work: The present study was to illustrate the incidence of conversion of laparoscopic cholecystectomy to open cholecystectomy & to validate the efficacy of "CLOC" (Conversion from Laparoscopic to open cholecystectomy) risk scoring system on the patients included in the study.Patients and methods: The present observational prospective study was conducted in EL-Demerdash Teaching Hospital (January 2019-January 2020). The study included (100) symptomatic cholelithiasis patients. Patients were divided into two groups, firstly those who completed laparoscopic cholecystectomy and secondly those who were converted into open cholecystectomy. Preoperative variables included patient demographics, indications for surgery, ASA grade, admission type, ultrasound findings and preoperative endoscopic retrograde cholangiopancreatography (ERCP). Validation of the "CLOC" scoring system was applied to all patients. Operative data were gathered prospectively, and the difficulty of the procedure was graded using the Nassar scale (grades 1-4).Results: (24%) of patients recorded difficult total score; open surgery was conducted in (5%). There was statistically significant relation between CLOC risk scoring level and age (p<0.001); indication (p=0.002); ASA (p=0.002); gallbladder wall thickness. (p<0.001) and preoperative ERCP patients (p=0.003). There was statistically significant increase in difficulty in male compared to female. (p=0.019). There was actual conversion according to groups with 'high risk scoring >7 and conversions in the' low risk >6 easy' group below. (p=0.042); highly statistically significant increase of mean in difficult group compared to essay group (p<0.001). The difficult group complications rate was higher than the easy group (75% versus 10.5%); gallbladder rupture was mostly reported in (37.5% and 2.6%) of difficult group and easy group cases, respectively. Receiver operating characteristics (ROC) curve sensitivity was 92%; specificity was 98.7%. Age, gender, indication, ASA, gallbladder wall and Pre-Operative ERCP have a significant effect on the difficulty. Conclusion:The present study could conclude that parameters as older age, male gender, cholecystitis, ASA, thick wall GB, preoperative ERCP are predictors for difficult LC. Meanwhile these

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Section: Resultsmentioning

confidence: 87%

“…x2: Chi-square test; *p-value <0.05 S; Table(7): Relation between researcher observation and level of CLOC risk scoring r: Spearman's Correlation Coefficient; **p-value <0.001 HS…”

mentioning

confidence: 99%

A Prospective Study of the Incidence of Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy in 100 Patients

Grace¹,

Kamel

Rafik

et al. 2021

Ain Shams Medical Journal

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“…[23][24][25] Despite these concerns, systematic studies indicate that laparoscopic procedures in elderly patients offer many advantages, such as lower pain and convalescence, and clinicians still tend to prefer laparoscopy in the elderly in both emergent or elective settings. 11,26,27 Our multivariable linear regression model illustrated that elective admissions, laparoscopic operations, and younger patients were associated with lower hospital stays and total costs. 3 This model also showed that women had lower total costs and shorter hospital stays than men.…”

Section: Resultsmentioning

confidence: 88%

Trends and Factors Impacting Healthcare Charges and Length of Stay for Cholecystectomies: A New York State Population-based Analysis

Darbandi¹,

Chopra²

2021

Int J Med Students

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Background: Gallbladder disease confers a significant economic toll on the United States healthcare system. This study aims to characterize current trends and features of the cholecystectomy population and identify factors that influence the length of stay and total charges. Methods: Case information was extracted for laparoscopic and open cholecystectomies from 2013-2016 using the New York Statewide Planning and Research Cooperative System (SPARCS) database. Descriptive, comparative, and multivariable linear regression analysis was conducted on 58,141 cases assessing age group, race, gender, admission presentation, surgical technique, insurance status, year of operation and severity of illness by the length of stay and total charges. Results: Of all procedures, 91.6% were laparoscopic, and 79.4% were emergent on admission. Total procedures trended down, while laparoscopic and emergent cases steadily increased (p<0.0001). Total charges increased during the study period, while the length of stay decreased (p<0.0001). Open and emergent procedures were associated with a higher cost and longer inpatient stays (p<0.0001). Open procedures were proportionally more common among elderly, male patients, and elective cases (p<0.0001). Emergent presentation was more common in females, non-whites, and younger patients (p<0.0001). Regression model showed that male gender, open operation, Black race, and emergent presentation were independent predictors for a longer stay and greater total charges (p<0.0001). Medicare insurance predicted lower total charges but longer length of stay (p<0.0001). Conclusion: Race, insurance, procedure type, and patient presentation influence hospital charges and stays following cholecystectomy. Understanding these trends will allow policymakers and providers to limit the healthcare burden of cholecystectomy.

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“…In this study, it was recommended that laparoscopic appendectomy be treated with long-term analgesia. In addition, laparoscopic appendectomy was known to be a low-risk operation [ 48 ]; however, the desire for a multimodality approach to treatment has been shown to be essential [ 49 ]. However, it is necessary to control inflammatory factors in the periphery, the surgical procedure itself produces an increase in inflammation, which is the cause of the procedure.…”

Section: Resultsmentioning

confidence: 99%

Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review

et al. 2023

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Laparoscopic appendectomy (LA) is one of the most commonly performed surgical procedures in children and is associated with extreme postoperative discomfort due to peritoneal inflammation and infection. The main objective of this study was to investigate the effects of postoperative pain (POP) in children after laparoscopic appendectomy. Articles describing or evaluating the control of POP in children with LA were considered eligible. All available literature such as randomized controls, prospective controls, retrospective as well as clinical studies were considered. A comprehensive search was performed in PubMed, Medline, Embase, Cochrane Library, Clinical trials.gov, and Google scholar. The initial search took place on 23 April 2021, and was updated on 24 August 2021. There were no language or date restrictions. Each of the included articles was evaluated separately by two independent reviewers. Additional papers were found by searching the reference lists of eligible studies. Eighteen papers were considered. All papers, and many of them used different methods to treat POP in children undergoing LA, such as lidocaine infusion, different analgesic approaches, ultrasound-guided transverse abdominis blockade (UGTAP), ultrasound-guided quadratus lumborum blockade (UGQLB), and comparison of open appendectomy (OA) with local anesthetics in relation to POP management in children. Laparoscopic appendectomy is the surgical procedure preferred by clinicians compared with open appendectomy in children. A multimodal analgesic approach is optimal and efficient surgical techniques such as UGBRSB, UGQLB, and UGTAP block might significantly impact POP in children except that there are contraindications. Dexmedetomidine proved to be an effective adjuvant that can enhance the effect of local anesthetics. The lack of a sufficient number of studies may be a factor affecting our confidence in the results of this study. Therefore, further evidence-based randomized control trials with a large sample size are needed to provide clarity.

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Outcomes and risk factors of cholecystectomy in high risk patients: A case series

Cited by 9 publications

References 14 publications

A Prospective Study of the Incidence of Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy in 100 Patients

A Prospective Study of the Incidence of Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy in 100 Patients

Trends and Factors Impacting Healthcare Charges and Length of Stay for Cholecystectomies: A New York State Population-based Analysis

Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review

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