Background
Obesity is a risk factor for cholelithiasis leading to acute cholecystitis which is
treated with cholecystectomy. The purpose of this study was to analyze the associations
between body mass index class and the intended operative approach (laparoscopic versus
open) for and outcomes of cholecystectomy for acute cholecystitis.
Methods
We conducted a retrospective cohort study using the American College of Surgeons National
Surgical Quality Improvement Program data from 2008–2013. The effects of body mass
index class on intended procedure type (laparoscopic versus open), conversion from
laparoscopic to open operation, and outcomes after cholecystectomy were examined using
multivariable logistic regression.
Results
Data on 20,979 patients who underwent cholecystectomy for acute cholecystitis showed
that 18,228 (87%) had a laparoscopic operation; 639 (4%) of these patients required
conversion to an open approach; and 2,751 (13%) underwent intended open cholecystectomy.
There was an independent association between super obesity (body mass index 50+) and
an intended open operation (odds ratio 1.53, 95% confidence interval 1.14–2.05, P = .01). An intended open procedure (odds ratio 3.10, 95% confidence interval 2.40–4.02,
P < .0001) and conversion (odds ratio 3.45, 95% confidence interval 2.16–5.50, P < .0001) were associated with increased risk of death/serious morbidity in a model,
even when controlling for all other important factors. In the same model, body mass
index class was not associated with increased death/serious morbidity. Outcomes after
conversion were not substantially worse than outcomes after intended open cholecystectomy.
Conclusion
This study supports the possibility that an intended open approach to acute cholecystitis,
not body mass index class, is associated with worse outcomes after cholecystectomy.
An initial attempt at laparoscopy may benefit patients, even those at the highest
end of the body mass index spectrum.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010.JAMA. 2012; 307: 491-497
- Prevalence of childhood and adult obesity in the United States, 2011–2012.JAMA. 2014; 311: 806-814
- Obesity and the risk and prognosis of gallstone disease and pancreatitis.Best Pract Res Clin Gastroenterol. 2014; 28: 623-635
- Obesity and symptomatic cholelithiasis in childhood: Epidemiologic and case-control evidence for a strong relation.J Pediatr Gastroenterol Nutr. 2014; 58: 102-106
- Prospective study of abdominal adiposity and gallstone disease in US men.Am J Clin Nutr. 2004; 80: 38-44
- Cholesterol gallstone disease.Lancet. 2006; 368: 230-239
- Cholesterol gallstones: A fellow traveler with metabolic syndrome?.Am J Clin Nutr. 2004; 80: 1-2
- Weight, diet, and the risk of symptomatic gallstones in middle-aged women.N Engl J Med. 1989; 321: 563-569
Quality AfHRa. Statistics on hospital stays. HCUPnet: U.S. Department of Health and Human Services; 2015.
- A current profile and assessment of north american cholecystectomy: Results from the American College of Surgeons National Surgical Quality Improvement Program.J Am Coll Surg. 2010; 211: 176-186
- Difficult laparoscopic cholecystectomy: Current evidence and strategies of management.Surg Laparosc Endosc Percutan Tech. 2011; 21: 211-217
- Safety and efficacy of a laparoscopic cholecystectomy in the morbid and super obese patients.HPB (Oxford). 2015; 17: 600-604
- Obesity does not increase morbidity of laparoscopic cholecystectomy.J Surg Res. 2014; 190: 491-497
- Laparoscopic cholecystectomy in morbidly obese patients.Surg Endosc. 2001; 15: 1336-1339
- Age and obesity are independent predictors of bile duct injuries in patients undergoing laparoscopic cholecystectomy.World J Surg. 2015; 39: 1804-1808
- Obesity as a factor in laparoscopic cholecystectomy.Surg Endosc. 2007; 21: 774-776
- The contribution of acute cholecystitis, obesity, and previous abdominal surgery on the outcome of laparoscopic cholecystectomy.Am Surg. 2007; 73: 371-376
- Laparoscopic cholecystectomy in obese patients.Obes Surg. 2005; 15: 243-246
- Impact of obesity and associated diseases on outcome after laparoscopic cholecystectomy.Surg Laparosc Endosc Percutan Tech. 2012; 22: 509-513
- Comparison of results after one year between sleeve gastrectomy and gastric bypass in patients with BMI>/=50 kg/m(2).Surg Obes Relat Dis. 2015; 11: 785-790
- Roux-en-Y gastric bypass for super obese patients: What approach?.Int J Med Robot. 2016; 12: 276-282
- Underlying reasons associated with hospital readmission following surgery in the United States.JAMA. 2015; 313: 483-495
- The NSQIP: A new frontier in surgery.Surgery. 2005; 138: 837-843
- Acute cholecystitis: Risk factors for conversion to an open procedure.J Surg Res. 2015; 199: 357-361
- Physician's guide to obesity.([Internet]) Disease Management Project Cleveland Clinic, Cleveland (OH)2013 (Available from:)
- Feasibility and prognostic value of stress echocardiography in obese, morbidly obese, and super obese patients referred for bariatric surgery.Echocardiography. 2014; 31: 879-885
- Impact of laparoscopic Roux-en-Y gastric bypass on metabolic syndrome, inflammation, and insulin resistance in super versus morbidly obese women.Obes Surg. 2009; 19: 577-582
- Outcomes of laparoscopic Roux-en-Y gastric bypass in super-super-obese patients.Surg Obes Relat Dis. 2015; 11: 814-819
- Increases in morbid obesity in the USA: 2000–2005.Public Health. 2007; 121: 492-496
- Risk factors for conversion from laparoscopic to open surgery: Analysis of 2138 converted operations in the American College of Surgeons National Surgical Quality Improvement Program.Am Surg. 2013; 79: 914-921
- Morbidity and mortality associated with gastrectomy for gastric cancer.Ann Surg Oncol. 2014; 21: 3008-3014
- Contained anastomotic leaks after colorectal surgery: Are we too slow to act?.Arch Surg. 2009; 144 (discussion 8): 333-338
- Negative results of randomized clinical trials published in the surgical literature: Equivalency or error?.Arch Surg. 2001; 136: 796-800
- Understanding equivalence and noninferiority testing.J Gen Intern Med. 2011; 26: 192-196
- Trends, outcomes, and predictors of open and conversion to open cholecystectomy in Veterans Health Administration hospitals.Am J Surg. 2010; 200: 32-40
- Predicting patient patterns in veterans administration emergency departments.West J Emerg Med. 2011; 12: 204-207
- A nationwide study of conversion from laparoscopic to open cholecystectomy.Am J Surg. 2004; 188: 205-211
- Predicting conversion from laparoscopic to open cholecystectomy presented as a probability nomogram based on preoperative patient risk factors.Am J Surg. 2015; 210: 492-500
Article info
Publication history
Published online: July 14, 2016
Accepted:
May 13,
2016
Footnotes
CJN and SMD contributed equally to this work.
The authors have no financial disclosures or potential conflicts of interest to declare.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
