Background
Methods
Patients and data collection
Statistical analysis
Results
Conversion
Conversion (n = 84 22.5 %)a
| LC (n = 289) | Total (n = 373) | OR (95% CI) |
P
| |
---|---|---|---|---|---|
Gender; Male | 48 (25.4%) | 141 (48.8%) | 189 (50.7%) | 1.4 (0.9–2.3) | 0.178 |
Age in years, median (range) | 70 (30–92) | 61 (20–94) | 63(20–94) | NA | <0.001 |
Heart failure | 7 (29.2%) | 17 (5.9%) | 24 (6.4%) | 1.5 (0.6–3.6) | 0.420 |
Impaired renal function | 2 (18.2%) | 9 (3.1%) | 11 (2.9%) | 0.8 (0.2–3.6) | 1.000 |
Diabetes | 23 (33.8%) | 45 (15.6%) | 68 (18.2%) | 2.0 (1.2–3.6) | 0.014 |
Previous laparotomy on the upper abdomen | 8 (40.0%) | 12 (4.2%) | 20 (5.4%) | 2.4 (1.0–6.2) | 0.054 |
Previous laparotomy on the lower abdomenb
| 21 (23.9%) | 67 (24.3%) | 88 (24.6%) | 1.1 (0.6–1.9) | 0.805 |
Previous laparoscopic surgery on the abdomenb
| 7 (29.2%) | 17 (6.2%) | 24 (6.7%) | 1.4 (0.6–3.6) | 0.450 |
No previous surgeries | 52 (21.3%) | 192 (66.4%) | 244 (65.4%) | 0.8 (0.5–1.4) | 0.442 |
Duration of symptoms before admissionc
| |||||
< 24 h | 18 (14.4%) | 106 (40.2%) | 124 (36.9%) | 0.5 (0.3–0.9) | 0.018 |
24 h – 48 h | 13 (27.1%) | 35 (13.3%) | 48 (14.3%) | 1.4 (0.7–2.9) | 0.302 |
48 h – 72 h | 16 (25.0%) | 48 (18.2%) | 64 (19.0%) | 1.3 (0.7–2.4) | 0.439 |
> 72 h | 25 (25.3%) | 75 (28.4%) | 100 (29.8%) | 1.3 (0.8–2.3) | 0.299 |
Hours from admission to surgery, median (range, interquartile range) | 26 (3–109, 18–42) | 29 (3–144, 20–48) | 29 (3–144, 20–47) | NA | 0.156 |
Total duration from symptoms onset to surgeryc
| |||||
< 24 h | 12 (21.4%) | 44 (16.7%) | 56 (16.7%) | 1.0 (0.5–2.0) | 1.000 |
24 h - 48 h | 8 (16.3%) | 41 (15.5%) | 49 (14.6%) | 0.7 (0.3–1.5) | 0.346 |
48 h - 72 h | 16 (21.3%) | 59 (22.3%) | 75 (22.3%) | 1.0 (0.5–1.9) | 0.982 |
> 72 h | 35 (22.6%) | 120 (45.5%) | 155 (46.3%) | 1.2 (0.7–2.0) | 0.564 |
Clinical findings | |||||
Pain in right upper quadrant | 82 (23.1%) | 273 (94.5%) | 355 (95.2%) | 2.4 (0.5–10.7) | 0.235 |
Guarding | 41 (25.6%) | 119 (41.2%) | 160 (42.9%) | 1.4 (0.8–2.2) | 0.213 |
Signs of generalized peritonitis | 1 (50.0%) | 1 (0.3%) | 2 (0.5%) | 3.5 (0.2–56.0) | 0.400 |
Palpable gallbladder | 6 (30.0%) | 14 (4.8%) | 20 (5.4%) | 1.5 (0.6–4.1) | 0.410 |
Preoperative laboratory data, median of highest results (range, interquartile range)d
| |||||
CRP (mg/l) | 215 (3–471, 128–299) | 123 (3–524, 58–214) | 145 (3–524, 66–244) | NA | <0.001 |
WBCC (109/l) | 14 (7–38, 12–18) | 13 (2.5–32, 10–16) | 13 (2.5–38, 10–17) | NA | 0.018 |
ALAT (U/l) | 27 (5–222, 17–48) | 30 (4–705, 18–63) | 29 (4–705, 18–57) | NA | 0.214 |
AFOS (U/l) | 85 (48–371, 66–126) | 80 (24–621, 61–112) | 81 (24–621, 62–113) | NA | 0.075 |
Bilirubin (μmol/l) | 15 (4–121, 9–27) | 15 (2–230, 9–24) | 15 (2–230, 9–24) | NA | 0.668 |
Radiographic findingse
| |||||
Abscess | 1 (100.0%) | 0 | 1 (0.3%) | NA | 0.226 |
Free fluid | 9 (36.0%) | 16 (5.6%) | 25 (6.7%) | 2.0 (0.9–4.8) | 0.097 |
Thickened gallbladder wall | 72 (23.2%) | 239 (83.0%) | 311 (83.6%) | 1.2 (0.6–2.4) | 0.552 |
Preoperative ERCP | 3 (17.6%) | 14 (4.8%) | 17 (4.6%) | 0.7 (0.2–2.6) | 0.773 |
Surgical findings | |||||
Abscess | 10 (66.7%) | 5 (1.7%) | 15 (4.0%) | 7.7 (2.5–23.1) | <0.001 |
Perforated gallbladder | 12 (33.3%) | 24 (8.3%) | 36 (9.7%) | 1.8 (0.9–3.9) | 0.102 |
Gallbladder perforation during surgery | 43 (23.0%) | 144 (49.8%) | 187 (50.1%) | 1.1 (0.7–1.7) | 0.826 |
Gangrene of the gallbladder identified by surgeon | 58 (43.0%) | 77 (26.6%) | 135 (36.2%) | 6.4 (3.6–10.4) | <0.001 |
Removal of stones from common bile duct | 0 | 0 | 0 | NA | NA |
Lead surgeon specialist | 32 (25.2%) | 94 (32.5%) | 126 (33.8%) | 1.3 (0.8–2.1) | 0.342 |
Assistant present | 53 (29.9%)f
| 124 (42.9%) | 177 (48.1%) | 2.7 (1.6–4.6) | <0.001 |
Risk factor | OR (95% CI) |
P
|
---|---|---|
Analysis of preoperative risk factors only | ||
CRP over 150 mg/ml | 3.0 (1.8–5.0) | <0.001 |
Diabetes | 1.8 (1.0–3.3) | 0.045 |
Analysis including both preoperative and intraoperative risk factors | ||
Abscess | 9.2 (2.7–31.1) | <0.001 |
Age over 65 years | 1.9 (1.1–3.3) | 0.023 |
Gangrene of the gallbladder | 5.9 (3.4–10.2) | <0.001 |
Complications
Risk factor | One or more postoperative complications n = 67 (18.0%)a
| Patients without complications n = 306 | OR (95% CI) |
P
|
---|---|---|---|---|
Gender: Male | 44 (23.3%) | 145 | 2.1 (1.2–3.7) | 0.007 |
Age in years, median (range) | 70 (30–92) | 61 (20–94) | NA | 0.001 |
Heart failure | 7 (29.2%) | 17 | 2.0 (0.8–5.0) | 0.139 |
Impaired renal function | 6 (54.5%) | 5 | 5.9 (1.8–20.0) | 0.006 |
Diabetes | 18 (26.5%) | 50 | 1.9 (1.0–3.5) | 0.043 |
Previous laparotomy on the upper abdomen | 8 (40.0%) | 12 | 3.3 (1.3–8.5) | 0.008 |
Previous laparotomy on the lower abdomenb
| 16 (18.2%) | 72 | 1.0 (0.5–1.8) | 0.944 |
Previous laparoscopic surgery on the abdomenb
| 2 (8.3%) | 22 | 0.4 (0.1–1.7) | 0.276 |
No previous surgeries | 43 (17.7%) | 200 | 1.0 (0.5–1.6) | 0.854 |
Duration of symptoms before admissionc
| ||||
< 24 h | 18 (14.5%) | 106 | 0.8 (0.4–1.4) | 0.360 |
24 h – 48 h | 11 (22.9%) | 37 | 1.6 (0.7–3.3) | 0.235 |
48 h – 72 h | 10 (15.6%) | 54 | 0.9 (0.4–1.9) | 0.751 |
> 72 h | 18 (18.0%) | 82 | 1.1 (0.6–2.1) | 0.742 |
Hours from admission to surgery, median (range, interquartile range) | 26 (3–92, 16–43) | 29 (4–144, 20–48) | NA | 0.141 |
Duration from symptoms onset to surgeryc
| ||||
< 24 h | 9 (16.1%) | 47 | 0.9 (0.4–2.0) | 0.845 |
24 h - 48 h | 9 (18.4%) | 40 | 1.1 (0.5–2.5) | 0.777 |
48 h - 72 h | 14 (18.7%) | 61 | 1.2 (0.6–2.3) | 0.656 |
> 72 h | 24 (15.5%) | 131 | 0.8 (0.5–1.5) | 0.575 |
Clinical findings | ||||
Pain in right upper quadrant | 65 (18.3%) | 290 | 1.8 (0.4–8.0) | 0.438 |
Guarding | 33 (20.6%) | 127 | 1.4 (0.8–2.3) | 0.246 |
Signs of generalized peritonitis | 0 | 2 | NA | 1.000 |
Palpable gallbladder | 4 (20.0%) | 16 | 1.2 (0.4–3.6) | 0.767 |
Preoperative laboratory data, median of the highest results (range, interquartile range)d
| ||||
CRP (mg/l) | 209 (4–477, 114–303) | 131 (3–524, 62–232) | NA | <0.001 |
WBCC (109/l) | 14.4 (5.4–37.4, 10.8–18.5) | 12.7 (2.5–38, 10–16.5) | NA | 0.069 |
ALAT (U/l) | 31 (5–473, 18–74) | 28 (4–705, 18–51) | NA | 0.439 |
AFOS (U/l) | 91 (24–314, 68–118) | 79 (26–621, 61–113) | NA | 0.105 |
Bilirubin (μmol/l) | 19 (4–92, 11–25) | 14 (2–230, 9–24) | NA | 0.139 |
Radiographic findingse
| ||||
Abscess | 0 | 1 | NA | 1.000 |
Free fluid | 7 (28.0%) | 18 | 1.9 (0.7–4.7) | 0.182 |
Thickened gallbladder wall | 61 (19.6%) | 250 | 2.2 (0.9–5.4) | 0.069 |
Surgical findings and procedures | ||||
Preoperative ERCP | 3 (17.6%) | 14 | 1.0 (0.3–3.5) | 1.000 |
Abscess | 5 (33.3%) | 10 | 2.4 (0.8–7.2) | 0.160 |
Perforated gallbladder | 9 (25.0%) | 27 | 1.6 (0.7–3.6) | 0.234 |
Gallbladder perforation during surgery | 38 (20.3%) | 149 | 1.4 (0.8–2.4) | 0.452 |
Gangrene of the gallbladder identified by surgeon | 31 (23.0%) | 104 | 1.7 (1.0–2.9) | 0.058 |
Removal of stones from the common bile duct | 0 | 0 | NA | NA |
Duration of surgery in minutes, median (range, interquartile range) | 110 (60–196, 83–138) | 98 (34–240, 74–123) | NA | 0.023 |
Lead surgeon specialist | 24 (19.0%) | 102 | 1.1 (0.6–1.9) | 0.697 |
Assistant presentf
| 34 (19.2%) | 143 | 1.2 (0.7–2.0) | 0.540 |
Conversion | 25 (29.8%) | 59 | 2.5 (1.4–4.4) | 0.001 |
Risk factor | OR (95% CI) |
P
|
---|---|---|
Age over 65 years | 2.1 (1.2–3.6) | 0.012 |
Male gender | 2.1 (1.2–3.7) | 0.013 |
Impaired renal function | 4.8 (1.4–17.0) | 0.015 |
Conversion | 2.3 (1.3–4.1) | 0.006 |
Clavien-Dindo classification | LC (n = 289) | Conversion (n = 84) | Total (n = 373) | Treatment |
---|---|---|---|---|
Grade I-II | 24 (8.3%) | 15 (17.9%) | 39 (10.5%) | |
Infections | Antimicrobial medication | |||
Pneumonia | 8 | 4 | 12 | |
Superficial SSI | 4 | 2 | 6a
| |
Urinary tract infection | 1 | 1 | ||
Other infection | 1 | 2 | 3 | |
Arrhythmias | 4 | 4 | Antiarrhythmic medication | |
High blood pressure | 2 | 2 | Blood pressure medication | |
Perioperative MI | 2 | 2 | Medication | |
Respiratory insufficiency | 1 | 1 | 2 | Medication |
Congestion | 1 | 1 | 2 | Medication |
Urinary retention | 1 | 1 | Catheterisation | |
Postoperative delirium | 1 | 1 | Medication | |
Nausea | 1 | 1 | Antiemetic medication | |
Perihepatic hematoma | 1 | 1 | Follow-up | |
Wound hematoma | 1 | 1 | Change of dressings | |
Grade III a-b | 13 (4.5%) | 7 (8.3%) | 20 (5.4%) | |
Common bile duct stone | 5 | 5 | ERCP | |
Surgical site effusion | 4 | 4 | Drainage | |
Bile leak | 3 | 3a
| ERCP, stenting | |
Deep SSI; abscess | 2 | 1 | 3 | Drainage |
Wound dehiscence | 2 | 2 | Re-suturation | |
Bleeding from urinary catheter | 1 | 1 | Bladder washout | |
Intra-abdominal bleeding | 1 | 1 | Laparotomy | |
Pneumonia; pleural effusion | 1 | 1 | Thoracocentesis | |
Grade IV a-b | 2 (0.7%) | 1 (1.2%) | 3 (0.8%) | |
Respiratory failure | 2 | 1 | 3 | Intubation, CPAP |
Grade V | 3 (1.0%) | 2 (2.4%) | 5 (1.3%) | |
Sepsis | 1 | 1 | ||
Pneumonia | 1 | 1 | ||
Heart failure | 1 | 1 | ||
Anoxic brain injury during induction of anaesthesia | 1 | 1 | ||
Renal failure | 1 | 1 | ||
Total | 42 (14.5%) | 25 (29.8%) | 67 (18.0%) |