Outcomes of inpatient cholecystectomy among adults with cystic fibrosis in the United States

Mitchell L Ramsey; Lindsay A Sobotka; Somashekar G Krishna; Alice Hinton; Stephen E Kirkby; Susan S Li; Michael P Meara; Darwin L Conwell; Peter P Stanich

doi:10.4253/wjge.v13.i9.371

Outcomes of inpatient cholecystectomy among adults with cystic fibrosis in the United States

World J Gastrointest Endosc. 2021 Sep 16;13(9):371-381. doi: 10.4253/wjge.v13.i9.371.

Authors

Mitchell L Ramsey¹, Lindsay A Sobotka¹, Somashekar G Krishna¹, Alice Hinton², Stephen E Kirkby³, Susan S Li⁴, Michael P Meara⁵, Darwin L Conwell¹, Peter P Stanich⁶

Affiliations

¹ Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
² Division of Biostatistics, The Ohio State University College of Public Health, Columbus, OH 43210, United States.
³ Division of Pulmonary and Critical Care Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
⁴ Division of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
⁵ Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
⁶ Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States. peter.stanich@osumc.edu.

Abstract

Background: Symptomatic biliary and gallbladder disorders are common in adults with cystic fibrosis (CF) and the prevalence may rise with increasing CF transmembrane conductance regulator modulator use. Cholecystectomy may be considered, but the outcomes of cholecystectomy are not well described among modern patients with CF.

Aim: To determine the risk profile of inpatient cholecystectomy in patients with CF.

Methods: The Nationwide Inpatient Sample was queried from 2002 until 2014 to investigate outcomes of cholecystectomy among hospitalized adults with CF compared to controls without CF. A propensity weighted sample was selected that closely matched patient demographics, patient's individual comorbidities, and hospital characteristics. The propensity weighted sample was used to compare outcomes among patients who underwent laparoscopic cholecystectomy. Hospital outcomes of open and laparoscopic cholecystectomy were compared among adults with CF.

Results: A total of 1239 inpatient cholecystectomies were performed in patients with CF, of which 78.6% were performed laparoscopically. Mortality was < 0.81%, similar to those without CF (P = 0.719). In the propensity weighted analysis of laparoscopic cholecystectomy, there was no difference in mortality, or pulmonary or surgical complications between patients with CF and controls. After adjusting for significant covariates among patients with CF, open cholecystectomy was independently associated with a 4.8 d longer length of stay (P = 0.018) and an $18449 increase in hospital costs (P = 0.005) compared to laparoscopic cholecystectomy.

Conclusion: Patients with CF have a very low mortality after cholecystectomy that is similar to the general population. Among patients with CF, laparoscopic approach reduces resource utilization and minimizes post-operative complications.

Keywords: Cystic fibrosis; Laparoscopic cholecystectomy; Length of stay; Mortality; Nationwide Inpatient Sample; Symptomatic biliary disorders.