Risk factors for complications after cholecystectomy for common bile duct stones: An EAST multicenter study

Paterson, Cameron W; Young, Katelyn; Mulder, Michelle B.; Hochman, Beth; Coleman, Natasha; Goldenberg‐Sandau, Anna; Schweinsburg, Jennifer; Gelbard, Rondi B.; Tracy, Brett M.; Torres, Denise; Morris, David S.; Boyer, Ashley; Burruss, Sigrid; Luo-Owen, Xian; Cullinane, Daniel C.; Cullinane, Laura M.; Mendoza, April E.; Gaitanidis, Apostolos; Zielinski, Martin D.; Camazine, Maraya; Johnson, S. I.; Rattan, Rishi; Yeh, D. Dante; Saxe, Jonathan M.; Kinstedt, Daniel; Celii, Amanda; Venincasa, Kiran

doi:10.1016/j.surg.2020.04.011

Cited by 6 publications

(6 citation statements)

References 24 publications

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“…First, with respect to duration of surgery, a prolonged operative time is associated with major morbidity and mortality, as previously reported. 28,29 In earlier study, we reported the factors associated with infectious complications in patients who underwent major hepatectomy were reported. It was found that patients who have intraabdominal infection have significantly longer operative time than those in a nonintraabdominal infection group.…”

Section: Discussionmentioning

confidence: 99%

Association of the rate of bilirubin decrease with major morbidity in patients undergoing preoperative biliary drainage before pancreaticoduodenectomy

et al. 2021

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Objective: The objective of this study was to examine the relationship between the rate of bilirubin decrease following preoperative biliary drainage before pancreaticoduodenectomy and postoperative morbidity. Methods: Records of patients who underwent pancreaticoduodenectomy at the Department of Surgery in Ramathibodi Hospital between January 2008 and December 2019 were retrospectively reviewed. The patients were classified into either an adequate or inadequate drainage rate groups according to the bilirubin decrease rate. Major morbidity was defined as higher than grade II in the Clavien-Dindo classification. Risk factors for major morbidity were analyzed by logistic regression analysis. Results: In total, 166 patients were included in the study. Major morbidity was observed in 36 patients (21.6%). Adequate biliary drainage rate was observed in 39 patients (23.4%). Patients who had major morbidity were less likely to have come from the adequate biliary drainage rate group than the inadequate group (38.9% vs. 61.1%). However, through multivariate logistic analysis, only body mass index, operative time, and pancreatic duct diameter were independent factors associated with major morbidity, whereas the bilirubin decrease rate was not. Conclusions: Bilirubin decrease rate following preoperative biliary drainage has no significant association with major postoperative morbidity after pancreaticoduodenectomy.

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Section: Discussionmentioning

confidence: 99%

Association of the rate of bilirubin decrease with major morbidity in patients undergoing preoperative biliary drainage before pancreaticoduodenectomy

et al. 2021

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“…Open cholecystectomy is not necessarily associated with surgical complications, and should not be considered as such, but certainly has a consequence on the length of hospital stay and recovery period. Higher rates of conversion have been associated with longer time between ERCP and cholecystectomy [ 55 , 59 , 61 ]. Tracy et al also found a higher conversion rate despite the lack of any difference in surgical complications, emphasizing however, the impact on the postoperative length of stay [ 61 ].…”

Section: Discussionmentioning

confidence: 99%

“…Higher rates of conversion have been associated with longer time between ERCP and cholecystectomy [ 55 , 59 , 61 ]. Tracy et al also found a higher conversion rate despite the lack of any difference in surgical complications, emphasizing however, the impact on the postoperative length of stay [ 61 ].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, early cholecystectomy was not associated with increased surgical complications [ 4 , 15 , 27 , 28 , 31 , 53 ] or conversion to open surgery [ 19 , 25 , 27 , 28 , 31 , 53 , 55 , 62 ]. Some studies even demonstrated association with a better surgical outcome in early cholecystectomy [ 13 , 29 , 30 , 59 , 61 ]. Consequently, guidelines have been elaborated but with varying time frames [ 2 , 5 – 7 , 12 , 18 , 20 , 22 , 32 – 41 ] reflecting the lack of evidence of optimal timing of cholecystectomy [ 28 , 34 ] from the prospective randomized controlled trials [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event

Bergeron,

Doyon,

Manière

et al. 2023

Surg Endosc

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Background Gallstone disease will affect 15% of the adult population with concomitant common bile duct stone (CBDS) occurring in up to 30%. Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for removal of CBDS, as cholecystectomy for the prevention of recurrent biliary event (RBE). RBE occurs in up to 47% if cholecystectomy is not done. The goal of this study was to evaluate the timing of occurrence of RBE after common bile duct clearance with ERCP and associated outcomes. Methods The records of all patients who underwent ERCP for gallstone disease followed by cholecystectomy, in a single center from 2010 to 2022, were reviewed. All RBE were identified. Actuarial incidence of RBE was built. Patients with and without RBE were compared. Results The study population is composed of 529 patients. Mean age was 58.0 (18–95). There were 221 RBE in 151 patients (28.5%), 39/151 (25.8%) having more than one episode. The most frequent RBE was acute cholecystitis (n = 104) followed by recurrent CBDS (n = 95). Median time for first RBE was 34 days. Actuarial incidence of RBE started from 2.5% at 7 days to reach 53.3% at 1 year. Incidence-rate of RBE was 2.9 per 100 person-months. Patients with RBE had significant longer hospitalisation time (11.7 vs 6.4 days; P < 0.0001), longer operative time (66 vs 48 min; P < 0.0001), longer postoperative stay (2.9 vs 0.9 days; P < 0.0001), higher open surgery rate (7.9% vs 1.3%; P < 0.0001), and more complicated pathology (23.8% vs 5.8%; P < 0.0001) and cholecystitis (64.2% vs 25.9%; P < 0.0001) as final diagnoses. Conclusions RBE occurred in 28.5% of the subjects at a median time of 34 days, with an incidence of 2.5% as early as 1 week. Cholecystectomy should be done preferably within 7 days after common bile duct clearance in order to prevent RBE and adverse outcomes.

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“…In this study, BMI cutoff was set at 25 kg/m 2 and median BMI in the obese group was 28.1 kg/m 2 , as the standard was adjusted for Asian collectives [55]. Known risk factors for complications after cholecystectomy are increased operative time, worsening leukocytosis, and jaundice, whereas risk factors for a 30-day readmission were prior biliary complication, male sex, and operative duration in a prospective multicenter study from the USA including 989 patients [56]. Obesity is over multiple studies no risk factor for postoperative complications.…”

Section: Surgical Field and Postoperative Outcomesmentioning

confidence: 99%

Impact of Excess Body Weight on Postsurgical Complications

Plassmeier

Hankir

Seyfried³

2021

Visc Med

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Background: Obesity is considered a risk factor for postoperative complications as it can limit exposure to the operation field, thereby significantly prolonging surgery time. Obesity-associated comorbidities, such as low-grade systemic inflammation, impaired functional status, and type 2 diabetes, are independent risk factors for impaired anastomotic wound healing and nonsurgical site infections. If obesity itself is an independent risk factor for surgical complications remains controversial, but the reason for this is largely unexplored. Summary: A MEDLINE literature search was performed using the terms: “obesity,” “excess body weight,” and “surgical complications.” Out of 65,493 articles 432 meta-analyses were screened, of which 25 meta-analyses were on the subject. The vast majority of complex oncologic procedures in the field of visceral surgery have shown higher complication rates in obese patients. Meta-analyses from the last 10 to 15 years with high numbers of patients enrolled consistently have shown longer operation times, higher blood loss, longer hospital stay for colorectal procedures, oncologic upper gastrointestinal (GI) procedures, and pancreatic surgery. Interestingly, these negative effects seem not to affect the overall survival in oncologic patients, especially in esophageal resections. A selection bias in oncologic upper GI patients may have influenced the results with higher BMI in upper GI cancer to be a predictor for better nutritional and performance status. Key Messages: Contrary to bariatric surgery, only limited evidence indicated that site and type of surgery, the approach to the abdominal cavity (laparoscopic vs. open), institutional factors, and the type of perioperative care such as ERAS protocols may play a role in determining postsurgical complications in obese patients. The initial question remains therefore partially unanswered. Large nationwide register-based studies are necessary to better understand which aspects of obesity and its related comorbidities define it as a risk factor for surgical complications.

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Risk factors for complications after cholecystectomy for common bile duct stones: An EAST multicenter study

Cited by 6 publications

References 24 publications

Association of the rate of bilirubin decrease with major morbidity in patients undergoing preoperative biliary drainage before pancreaticoduodenectomy

Association of the rate of bilirubin decrease with major morbidity in patients undergoing preoperative biliary drainage before pancreaticoduodenectomy

Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event

Impact of Excess Body Weight on Postsurgical Complications

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