Introduction
Methods
Swedish Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks)
Study Design
Definitions
-
Intraoperative adverse events are defined as bleeding, bile duct injury, gut perforation, or any other reason for the cholecystectomy to be terminated prematurely.
-
Intraoperative bleeding demanding intervention is defined as any bleeding requiring blood transfusion or conversion to open surgery. Bleeding that is controlled completely with diathermy, clips, or sutures is not considered to be intraoperative bleeding demanding an intervention. Data are not filed on the volume of blood loss and number of transfused blood units.
-
Bile duct injury (BDI) is defined as intraoperatively registered (a) BDI ≤1/3 of the diameter, (b) BDI >1/3 of the diameter, (c) resection of a substantial part of the bile duct wall, or (d) complete transection of the bile duct.
-
Postoperative adverse events are defined as any complication during the 30-day follow-up period that required some form of medical or surgical intervention.
Statistics
Ethical considerations
Results
AC (n = 15,760) | No AC (n = 71,348) |
P
| |||
---|---|---|---|---|---|
n
| % |
n
| % | ||
Gender | |||||
Females | 8376 | 53.15 | 50,526 | 70.82 |
<0.0001
|
Males | 7384 | 46.85 | 20,822 | 29.18 | |
Age (years)a
| |||||
>50 | 9731 | 61.97 | 33,073 | 46.42 |
<0.0001
|
≤50 | 5971 | 38.03 | 38,169 | 53.58 | |
ASA | |||||
1–2 | 13,792 | 87.51 | 66,965 | 93.86 |
<0.0001
|
≥3 | 1968 | 12.49 | 4383 | 6.14 | |
Op technique | |||||
LC (Op started with laparoscopic technique) | 12,522 | 79.45 | 68,803 | 96.43 |
<0.0001
|
Convertedb
| 2520 | 20.12 | 3622 | 5.26 |
<0.0001
|
Antibiotics | |||||
Prophylactic | 4531 | 28.75 | 11,859 | 16.62 |
<0.0001
|
Treatment | 7963 | 50.53 | 3002 | 4.21 | |
No antibiotics | 3266 | 20.72 | 56,487 | 79.17 | |
Hospital stay (days)c
| Mean | SEM | Mean | SEM | |
Length of postop stay | 3.52 | 0.04 | 1.59 | 0.01 |
<0.0001
|
LC postop stay | 2.98 | 0.04 | 1.43 | 0.01 |
<0.0001
|
OC postop stay | 5.60 | 0.11 | 5.69 | 0.15 | 0.5988 |
Number | Percent | Univariate | Multivariatea
| ||||
---|---|---|---|---|---|---|---|
AE | No AE | OR (95 % CI) |
P
| OR (95 % CI) |
P
| ||
Intraop AE | |||||||
No AC | 2028 | 69,320 | 2.84 | 1.0 (reference) | 1.0 (reference) | ||
AC | 618 | 15,142 | 3.92 | 1.40 (1.27–1.53) |
<0.0001
| 1.23 (1.12–1.35) |
<0.0001
|
Intraop bleeding | |||||||
No AC | 496 | 70,852 | 0.70 | 1.0 (reference) | 1.0 (reference) | ||
AC | 234 | 15,526 | 1.48 | 2.15 (1.84–2.51) |
<0.0001
| 1.54 (1.30–1.82) |
<0.0001
|
Intraop bile duct injury | |||||||
No AC | 201 | 71,147 | 0.28 | 1.0 (reference) | 1.0 (reference) | ||
AC | 67 | 15,693 | 0.43 | 1.51 (1.14–1.98) |
0.0048
| 1.44 (1.08–1.90) |
0.0137
|
Postop AE | |||||||
No AC | 5250 | 66,098 | 7.36 | 1.0 (reference) | 1.0 (reference) | ||
AC | 1896 | 13,864 | 12.03 | 1.72 (1.63–1.82) |
<0.0001
| 1.38 (1.26–1.51) |
<0.0001
|
Mortality (≤30 days) | |||||||
No AC | 47 | 71,301 | 0.07 | 1.0 (reference) | 1.0 (reference) | ||
AC | 73 | 15,687 | 0.46 | 7.06 (4.91–10.25) |
<0.0001
| 1.25 (0.67–2.22) | 0.4720 |
Mortality (≤90 days) | |||||||
No AC | 100 | 71,248 | 0.14 | 1.0 (reference) | 1.0 (reference) | ||
AC | 129 | 15,631 | 0.82 | 5.88 (4.53–7.65) |
<0.0001
| 1.04 (0.72–1.49) | 0.8137 |
Time between admission and treatment (days) | Number (n = 15,189a) | Univariate | Multivariatea
| ||||
---|---|---|---|---|---|---|---|
Yes | No | % | OR (95 % CI) |
P
| OR (95 % CI) |
P
| |
Intraoperative AE | |||||||
≥5 | 44 | 709 | 5.84 | 1.0 (reference) | 1.0 (reference) | ||
4 | 37 | 718 | 4.90 | 0.83 (0.53–1.30) | 0.4166 | 0.88 (0.56–1.38) | 0.5819 |
3 | 78 | 1703 | 4.38 | 0.74 (0.51–1.09) | 0.1221 | 0.81 (0.55–1.19) | 0.2811 |
2 | 146 | 3997 | 3.52 | 0.59 (0.42–0.84) |
0.0041
| 0.66 (0.47–0.95) |
0.0261
|
1 | 212 | 5745 | 3.56 | 0.59 (0.43–0.84) |
0.0038
| 0.67 (0.49–0.96) |
0.0285
|
Admission day | 71 | 1729 | 3.94 | 0.66 (0.45–0.98) |
0.0393
| 0.74 (0.50–1.10) | 0.1377 |
Intraoperative bleeding | |||||||
≥5 | 15 | 738 | 1.99 | 1.0 (reference) | 1.0 (reference) | ||
4 | 15 | 740 | 1.99 | 1.00 (0.48–2.07) | 0.9941 | 1.14 (0.55–2.38) | 0.7254 |
3 | 29 | 1752 | 1.63 | 0.81 (0.44–1.57) | 0.5271 | 0.97 (0.52–1.88) | 0.9187 |
2 | 61 | 4082 | 1.47 | 0.74 (0.43–1.35) | 0.3052 | 0.94 (0.54–1.73) | 0.8347 |
1 | 80 | 5877 | 1.34 | 0.67 (0.40–1.21) | 0.1771 | 0.86 (0.50–1.57) | 0.6054 |
Admission day | 28 | 1772 | 1.56 | 0.78 (0.42–1.50) | 0.4417 | 0.97 (0.52–1.88) | 0.9255 |
Bile duct injury intraoperatively | |||||||
≥5 | 7 | 746 | 0.93 | 1.0 (reference) | 1.0 (reference) | ||
4 | 4 | 751 | 0.53 | 0.57 (0.15–1.89) | 0.3586 | 0.59 (0.15–1.97) | 0.3950 |
3 | 12 | 1769 | 0.67 | 0.72 (0.29–1.95) | 0.5037 | 0.78 (0.31–2.11) | 0.6106 |
2 | 16 | 4127 | 0.39 | 0.41 (0.18–1.08) |
0.0691
| 0.45 (0.19–1.18) | 0.1007 |
1 | 22 | 5935 | 0.37 | 0.40 (0.18–1.00) |
0.0505
| 0.43 (0.19–1.11) |
0.0780
|
Admission day | 3 | 1797 | 0.17 | 0.18 (0.04–0.64) |
0.0081
| 0.19 (0.04–0.68) |
0.0107
|
Postoperative AE | |||||||
≥5 | 130 | 623 | 17.26 | 1.0 (reference) | 1.0 (reference) | ||
4 | 80 | 675 | 10.60 | 0.57 (0.42–0.76) |
0.0002
| 0.61 (0.45–0.82) |
0.0012
|
3 | 209 | 1572 | 11.73 | 0.64 (0.50–0.81) |
0.0002
| 0.71 (0.56–0.90) |
0.0055
|
2 | 480 | 3663 | 11.59 | 0.63 (0.51–0.78) |
<0.0001
| 0.72 (0.58–0.90) |
0.0041
|
1 | 700 | 5257 | 11.75 | 0.64 (0.52–0.79) |
<0.0001
| 0.73 (0.60–0.91) |
0.0044
|
Admission day | 227 | 1573 | 12.61 | 0.69 (0.55–0.88) |
0.0024
| 0.78 (0.62–1.00) |
0.0468
|
Mortality (≤30 days) | |||||||
≥5 | 10 | 743 | 1.33 | 1.0 (reference) | 1.0 (reference) | ||
4 | 10 | 745 | 1.32 | 1.00 (0.41–2.44) | 0.9952 | 1.36 (0.54–3.43) | 0.5030 |
3 | 8 | 1773 | 0.45 | 0.34 (0.13–0.85) |
0.0223
| 0.49 (0.18–1.28) | 0.1465 |
2 | 16 | 4127 | 0.39 | 0.29 (0.13–0.66) |
0.0042
| 0.52 (0.23–1.21) | 0.1245 |
1 | 18 | 5939 | 0.30 | 0.23 (0.11–0.51) |
0.0007
| 0.40 (0.18–0.93) |
0.0344
|
Admission day | 10 | 1790 | 0.56 | 0.42 (0.17–1.02) |
0.0539
| 0.62 (0.25–1.56) | 0.3096 |
Mortality (≤90 days) | |||||||
≥5 | 22 | 731 | 2.92 | 1.0 (reference) | 1.0 (reference) | ||
4 | 13 | 742 | 1.72 | 0.58 (0.28–1.15) | 0.1198 | 0.77 (0.37–1.57) | 0.4794 |
3 | 15 | 1766 | 0.84 | 0.28 (0.14–0.54) |
0.0002
| 0.40 (0.20–0.79) |
0.0085
|
2 | 30 | 4113 | 0.72 | 0.24 (0.14–0.43) |
<0.0001
| 0.42 (0.24–0.76) |
0.0048
|
1 | 29 | 5928 | 0.49 | 0.16 (0.09–0.29) |
<0.0001
| 0.28 (0.16–0.51) |
<0.0001
|
Admission day | 17 | 1783 | 0.94 | 0.32 (0.16–0.60) |
0.0004
| 0.47 (0.24–0.91) |
0.0253
|