SAN ANTONIO (EGMN)–Open surgery and the presence of two or more comorbidities were the strongest predictors of increased in-hospital mortality following cholecystectomy in a large, retrospective study.
Black race and urgent admission also were associated with elevated risk, Dr. SreyRam Kuy said at the annual Academic Surgical Congress.
Even though cholecystectomy is routine surgery, Dr. Kuy and her associates wanted to identify predictors of in-hospital mortality so that preoperatively, surgeons could give more consideration to patients at elevated risk.
The findings emerged from a subanalysis of 795,031 procedures from 1999 to 2006 entered in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database. Cholecystectomy was the primary procedure during hospitalization for 628,419, or 79%, of these patients. The subanalysis comprised 385,824 age-matched adult men and women admitted for cholecystectomy.
An initial study of the total cohort revealed that men had a higher in-hospital mortality rate (1.1%, compared with 0.6% for women). “Women comprise the majority of hospitalizations for cholecystectomy [65%], are younger, have fewer comorbidities, and are more likely to have laparoscopy,” said Dr. Kuy of the Medical College of Wisconsin, Milwaukee. Women also are less likely to be admitted on an emergent basis, which may be another reason for their lower mortality rates, she said.
Because men were significantly older than women were at the time of admission (mean age 61 vs. 54 years, respectively), Dr. Kuy and her associates controlled for age to determine more. They found triple the risk of in-hospital mortality with open versus laparoscopic cholecystectomy (odds ratio, 3.01) and the presence of two or more comorbidities (OR, 3.33) versus one or none in the subanalysis. Male gender (OR, 1.33), being black (OR, 1.30), and urgent admission (OR, 1.4) also were associated with elevated risk.
A meeting attendee asked about mortality by hospital type. The study looked at community versus teaching hospitals, region, and other factors. “The one thing that did stand out was those treated at an urban hospital had a higher risk of mortality than [did] others [OR, 1.20],” Dr. Kuy replied.
Another attendee commented that a 1.1% mortality rate for men seemed high. These are preliminary, population-based data, Dr. Kuy pointed out, adding that she would like to conduct further analyses to adjust for factors other than age and gender, such as type of biliary disease.
Dr. Kuy had no relevant financial disclosures.
