Original scientific article
Risk Factors for Perioperative Complications in Patients Undergoing Laparoscopic Cholecystectomy: Analysis of 22,953 Consecutive Cases from the Swiss Association of Laparoscopic and Thoracoscopic Surgery Database

https://doi.org/10.1016/j.jamcollsurg.2006.07.018Get rights and content

Background

Reliable risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy would be extremely useful to optimize the clinical management. This study aimed to determine risk factors that can be used for predicting perioperative complications.

Study design

Possible risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy for acute and chronic cholecystitis were analyzed by a stepwise logistic regression model using data from the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) database.

Results

A total of 22,953 patients with a mean (± SD) age of 54.5 ± 16.1 years (range 17 to 89 years) and a male-to-female ratio of 1:2, underwent elective (85%) and emergency (15%) laparoscopic cholecystectomy. Multivariable analysis showed that male gender (odds ratio [OR] = 1.16; p < 0.0001), duration of intervention (OR = 1.68 per 30 minutes; p < 0.0001), body weight (> 90 kg versus < 60 kg; OR = 1.34; p < 0.0001), and the surgeon’s own experience (> 100 versus 11 to 100 interventions; OR = 1.36; p < 0.0002) were independently associated with an increased intraoperative local complication rate. In addition, male gender (OR = 1.21; p < 0.02), age (OR = 1.12 per 10 years; p < 0.0001), intraoperative complications (OR = 2.1; p < 0.0001), conversion to open surgery (OR = 1.25; p < 0.01), American Society of Anesthesiologists risk score (ASA score III/IV versus I/II: OR = 1.28; p < 0.0005), body weight (< 60 kg versus > 90 kg; OR = 1.53; p < 0.007), emergency surgery (OR = 1.36; p < 0.003), and duration of surgery (OR = 1.28 per 30 minutes; p < 0.0001) were found to be associated with a higher incidence of postoperative local complications. Higher postoperative systemic complications were encountered with conversion (OR = 1.5; p < 0.0002), ASA score (III/IV versus I/II: OR = 1.54; p < 0.0001), emergency surgery (OR = 1.41; p < 0.001), and a prolonged intervention time (OR = 1.16 per 30 minutes; p < 0.0001).

Conclusions

For patients undergoing laparoscopic cholecystectomy (LC), the risk of possible perioperative complications can be estimated based on patient characteristics (gender, age, ASA score, body weight), clinical findings (acute versus chronic cholecystitis), and the surgeon’s own clinical practice with LC. 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 LC lasts longer than 2 hours, the cumulative risk for perioperative complications is four times higher compared with an intervention that lasts between 30 and 60 minutes, independent of the surgeon’s personal skills with LC.

Section snippets

Methods

Between 1995 and 2003, Swiss Association of Laparoscopic and Thoracoscopic Surgery prospectively collected data from patients undergoing laparoscopic surgery at 114 surgical institutions (university, county, district hospitals, and surgeons in private practice). This database documents about 65% of all laparoscopic interventions performed in Switzerland. More than 130 data items, including detailed personal data, indication for surgery, intraoperative course, local and general intra- and

Patient characteristics and perioperative outcomes of laparoscopic cholecystectomy

Patient characteristics and the perioperative outcomes of LC are reported in Table 1, Table 2. Between 1995 and 2003, a total of 22,953 patients with a mean age of 54.5 ± 16.1 years (male: female ratio of 1:2) underwent either routine or emergency LC. Indications for surgery were AC (5,118 [22.3%]) and CC (17,835 [77.7%]). An emergency intervention was performed in 3,367 (14.7%) patients. An ASA score (I/II) was found in 88.3% of patients. Although an overall intraoperative complication rate of

Discussion

The aim of our study was to identify factors that can be used to predict an individual patient’s perioperative risk profile. To investigate various factors, we used a multivariate stepwise logistic regression model. Compared with CC, AC was found to have 1.86, 1.36, and 1.38 times higher risks of intraoperative, and local, and systemic postoperative complications, respectively. The most frequent intraoperative complications reported by the surgeons were difficulties with surgical exposure and

Acknowledgment

We thank D Pfluger, PhD (Datametrix Ltd., Zurich, Switzerland) for statistical analysis.

References (17)

  • M. Schäfer et al.

    Predictive factors for the type of surgery in acute cholecystitis

    Am J Surg

    (2001)
  • F.A. Habib et al.

    Role of laparoscopic cholecystectomy in the management of gangrenous cholecystitis

    Am J Surg

    (2001)
  • C. Mühe

    Cholecystektomie durch das Laparoskop

    Langenbecks Arch Klein Chir

    (1986)
  • C.K. Kum et al.

    Laparoscopic cholecystectomy for acute cholecystitis: is it really safe?

    World J Surg

    (1996)
  • S. Adamsen et al.

    Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series

    J Am Coll Surg

    (1997)
  • B. Navez et al.

    Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases

    World J Surg

    (2001)
  • J.A. Lujan et al.

    Laparoscopic cholecystectomy vs. open cholecystectomy in the treatment of acute cholecystitis: a prospective study

    Arch Surg

    (1998)
  • P.B. Lai et al.

    Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

    Br J Surg

    (1998)
There are more references available in the full text version of this article.

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Competing Interests Declared: None.

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Copyright © 2006 American College of Surgeons. Published by Elsevier Inc. All rights reserved.