Are outcomes for emergency index-admission laparoscopic cholecystectomy performed by hepatopancreatobiliary surgeons better compared to non-hepatopancreatobiliary surgeons? A 10-year audit using 1:1 propensity score matching

Kai Siang Chan; Samantha Baey; Vishal G Shelat; Sameer P Junnarkar

doi:10.1016/j.hbpd.2023.08.002

Are outcomes for emergency index-admission laparoscopic cholecystectomy performed by hepatopancreatobiliary surgeons better compared to non-hepatopancreatobiliary surgeons? A 10-year audit using 1:1 propensity score matching

Hepatobiliary Pancreat Dis Int. 2023 Aug 3:S1499-3872(23)00121-2. doi: 10.1016/j.hbpd.2023.08.002. Online ahead of print.

Authors

Kai Siang Chan¹, Samantha Baey², Vishal G Shelat³, Sameer P Junnarkar⁴

Affiliations

¹ Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore. Electronic address: kchan023@e.ntu.edu.sg.
² Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore.
³ Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
⁴ Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.

PMID: 37586993
DOI: 10.1016/j.hbpd.2023.08.002

Abstract

Background: Emergency index-admission cholecystectomy (EIC) is recommended for acute cholecystitis in most cases. General surgeons have less exposure in managing "difficult" cholecystectomies. This study aimed to compare the outcomes of EIC between hepatopancreatobiliary (HPB) versus non-HPB surgeons.

Methods: This is a 10-year retrospective audit on patients who underwent EIC from December 2011 to March 2022. Patients who underwent open cholecystectomy, had previous cholecystitis, previous endoscopic retrograde cholangiopancreatography or cholecystostomy were excluded. A 1:1 propensity score matching (PSM) was performed to adjust for confounding variables (e.g. age ≥ 75 years, history of abdominal surgery, presence of dense adhesions).

Results: There were 1409 patients (684 HPB cases, 725 non-HPB cases) in the unmatched cohort. Majority (52.3%) of them were males with a mean age of 59.2 ± 14.9 years. Among 472 (33.5%) patients with EIC performed ≥ 72 hours after presentation, 40.1% had dense adhesion. The incidence of any morbidity, open conversion, subtotal cholecystectomy and bile duct injury were 12.4%, 5.0%, 14.6% and 0.1%, respectively. There was one mortality within 30 days from EIC. PSM resulted in 1166 patients (583 per group). Operative time was shorter when EIC was performed by HPB surgeons (115.5 min vs. 133.4 min, P < 0.001). The mean length of hospital stay was comparable. EIC performed by HPB surgeons was independently associated with lower open conversion [odds ratio (OR)= 0.24, 95% confidence interval (CI): 0.12-0.49, P < 0.001], lower fundus-first cholecystectomy (OR= 0.58, 95% CI: 0.35-0.95, P= 0.032), but higher subtotal cholecystectomy (OR= 4.19, 95% CI: 2.24-7.84, P < 0.001). Any morbidity, bile duct injury and mortality were comparable between the two groups.

Conclusion: EIC performed by HPB surgeons were associated with shorter operative time and reduced risk of open conversion. However, the incidence of subtotal cholecystectomy was higher.

Keywords: Bail-out; Cholecystectomy; Cholecystitis; Open conversion; Tokyo guidelines.