Bail Out Procedures in Acute Cholecystitis: Risk Factors and Optimal Approach.

IF 1 4区医学 Q3 SURGERY American Surgeon Pub Date : 2024-11-28 DOI:10.1177/00031348241304008

Chaiss Ugarte, Ramsey Ugarte, Shea Gallagher, Stephen Park, Odeya Kagan, Ryan Murphy, Kazuhide Matsushima, Kenji Inaba, Matthew J Martin, Morgan Schellenberg

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Abstract

Background: For difficult cholecystectomies, bail out procedures (BOP) are performed to mitigate risk of patient harm.

Objective: This study sought to identify risk factors for BOP for acute cholecystitis and to compare outcomes by type of BOP performed. Methods: Patients with acute cholecystitis who underwent cholecystectomy were included (2020-2022). Demographics, clinical data, and outcomes were collected. Primary outcome was <30-day complication rate. Groups were defined by surgery performed: BOP vs Laparoscopic Complete Cholecystectomy (LCC). BOPs were defined as any deviation from laparoscopic complete cholecystectomy. Univariate analyses compared outcomes between groups. Multivariable analysis identified independent factors associated with BOP. Subgroup analysis compared outcomes of laparoscopic BOP vs open BOP.

Results: Of 728 patients, 659 (91%) underwent LCC and 69 (9%) underwent BOP: 34 (49%) laparoscopic BOP and 35 (51%) open BOP. Independent predictors of BOP included admission total bilirubin >0.2 mg/dL (OR 5.80, P = .017), >7 days of symptoms at time of cholecystectomy (OR 1.96, P = .019), and arrival heart rate >100 bpm (OR 1.82, P = .032). On subgroup analysis, laparoscopic vs open BOP demonstrated no difference in operative time (P = .536) and overall (P = .733) or gallbladder-related complications (P = .364), including bile leaks (P = .090). Laparoscopic BOP was associated with shorter postoperative lengths of stay (P = .005).

Conclusion: The risk factors for BOP identified in this study may help inform patient consent and operative planning. Laparoscopic BOP incurred equivalent complications to open BOP but with shorter hospital stays, challenging conventional dogma that conversion to open is the optimal approach for complicated acute cholecystitis.

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急性胆囊炎的救助程序：危险因素和最佳途径。

背景：对于困难的胆囊切除术，采用体外救助手术（BOP）来减轻患者伤害的风险。目的：本研究旨在确定急性胆囊炎BOP的危险因素，并比较不同类型BOP的结果。方法：纳入2020-2022年行胆囊切除术的急性胆囊炎患者。收集了人口统计学、临床数据和结果。主要结局为：728例患者中，659例（91%）接受了LCC， 69例（9%）接受了BOP: 34例（49%）接受了腹腔镜BOP， 35例（51%）接受了开放式BOP。BOP的独立预测因子包括入院总胆红素>0.2 mg/dL （OR 5.80, P = 0.017）、胆囊切除术时症状7天的> (OR 1.96, P = 0.019)和到达时心率>100 bpm （OR 1.82, P = 0.032）。在亚组分析中，腹腔镜与开放式BOP在手术时间（P = 0.536）和总体（P = 0.733）或胆囊相关并发症（P = 0.364），包括胆汁泄漏（P = 0.090）方面均无差异。腹腔镜BOP与较短的术后住院时间相关（P = 0.005）。结论：本研究确定的BOP危险因素可能有助于患者的同意和手术计划。腹腔镜BOP的并发症与开放式BOP相当，但住院时间较短，挑战了传统的信条，即转换为开放式是治疗复杂急性胆囊炎的最佳方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Surgeon 医学-外科

CiteScore

1.40

自引率

0.00%

发文量

623

期刊介绍： The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.