Outcome assessment between elective or urgent laparoscopic cholecystectomy
DOI:
https://doi.org/10.11606/issn.1679-9836.v99i3p266-271Keywords:
Cholecystectomy, laparoscopic, Elective surgical procedures, Intraoperative complicationsAbstract
Background: Laparoscopic cholecystectomy is gold standard treatment for cholecystolithiasis. It is classified as elective or urgent and there is a small amount of publications comparing these two moments of attendance. Aim: To analyze the results of elective and urgent laparoscopic cholecystectomy regarding the time between hospitalization and surgery, the length of hospitalization, complications, use of antimicrobials and drains, mortality, and cost. Methods: Retrospective analysis of 368 patients who underwent laparoscopic cholecystectomy. Data were collected from the medical records and from the hospital account of the patients. Results: Of 368 patients, 277 (75.3%) underwent elective cholecystectomy and 91 (24.7%) under emergency cholecystectomy. Of those submitted to the elective, 194 (70.04%) were women. The average age was 45,66±14,87 years. The average hospital stay was 26.60±16,85 hours. Two (0.72%) patients used antimicrobial therapy and 16 (5.78%) patients used drain. There were complications in 6 (2.17%) cases. The average cost was 3,157.76±1.882.22 reais. In emergency cholecystectomies, 61(67.03%) patients were women. The average age was 51.36±19,08 years. The average hospital stay was 108.27±96,11 hours. Antimicrobials were used by 33 (36.26%) patients and drain by 21(23.08%) patients. Complications occurred in 13 (14.29%) patients. Two (2.20%) patients died. The average cost was 9,357.00±7.224.14 reais. Analyzing the variables, the average cost of emergency cholecystectomies was three times the cost of electives. Conclusion: Urgent laparoscopic cholecystectomies have a considerably higher cost due to longer time between hospitalizations and surgeries, longer hospitalization time, higher complication rate, more use of drains and greater need for antimicrobial therapy when compared to elective procedures.
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References
Duman K, Sezer K.H, Yılmaz F, Akın M.L. The clinical outcome of traditional laparoscopic cholecystectomy. Gaziantep Med J. 2013;19(1):35-9. doi: 10.5455/GMJ-30-2012-118.
Conde LM, Tavares PM, Quintes JLD, Chermont RQ, Perez CA. Laparoscopic management of cholecystocolic fistula. Abcd, Arq Bras Cir Dig. 2014;27(4):285-7. doi: 10.1590/S0102-67202014000400013.
Kanakala V, Borowski DW, Pellen MGC, Dronamraju SS, Woodcock SAA., Seymour K, et al. Risk factors in laparoscopic cholecystectomy: a multivariate analysis. Int J Surg. 2011;9(4):318-23. doi: 10.1016/j.ijsu.2011.02.003.
To KB, Cherry-Bukowiec JR, Englesbe MJ, Terjimanian MN, Shijie C, Campbell DA, et al. Emergent versus elective cholecystectomy: conversion rates and outcomes. Surg Infect. 2013;14(6):512-9. doi: 10.1089/sur.2012.160.
Lucarelli P, Picchio M, Martellucci J, Angelis F, Filippo A, Stipa F, et al. Drain after laparoscopic cholecystectomy for acute calculous cholecystitis. A pilot randomized study. Indian J Surg. 2015;77(4):288-92. doi: 10.1007/s12262-012-0797-9.
Brasil. Ministério da Saúde. Portaria nº. 1919. Redefine, no âmbito do Sistema Único de Saúde - SUS, a prestação de procedimentos cirúrgicos eletivos. Diário Oficial da União, Brasília. 2010;197(7):479-521.
Datasus. Informações de saúde. Disponível em http://datasus.gov.br. Acesso em: 03/05/2018.
Felício SJO, Matos EP, Cerqueira AM, Farias KWS, Silva RA, Torres MO. Mortalidade da colecistectomia videolaparoscópica de urgência versus operação eletiva para colecistite aguda. ABCD Arq Bras Cir Dig. 2017;30(1):47-50. doi: 10.1590/0102-67202017000100013.
Polychronidis A, Botaitis S, Tsaroucha A, Tripsianis G, Bounovas A, Pitiakoudis M, Simopoulos C. Laparoscopic cholecystectomy in elderly patients. J Gastrointestin Liver Dis. 2008;6:273-84. Available from: http://www.jgld.ro/2008/3/10.pdf.
Wasana K, Trichak S, Sahattaya P, et al. Predictive factors for a long hospital stay in patients undergoing laparoscopic cholecystectomy. Int J Hepatol. 2017;5:145-57. doi: 10.1155/2017/5497936.
Radunovic M, Lazovic R, Popovic N, et al. Complications of laparoscopic cholecystectomy: our experience from a retrospective analysis. J Med Sci. 2016;4(4):641-6. doi: 10.3889/oamjms.2016.128.
Uludag M, Yetkin G, Citgez B. The role of prophylactic antibiotics in elective laparoscopic cholecystectomy. JSLS. 2009;13(3):337-41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015970/.
Souza HP, Breigeiron R, Cunha HM, Deves E. Antibioticoprofilaxia na colecistectomia videolaparoscópica eletiva: estudo prospectivo randomizado e duplo cego. Rev Col Bras Cir. 2008;35(3):168-72. doi: 10.1590/S0100-69912008000300006.
Uchiyama K, Kawai M, Onishi H, et al. Preoperative antimicrobial administration for prevention of postoperative infection in patients with laparoscopic cholecystectomy. Dig Dis Sci. 2003;48(10):1955-9. doi: 10.1023/a:1026114203622.
Gomi H, Solomkin, JS, Schlossberg, D et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25:3-16. doi: 10.1002/jhbp.518.
Pellegrini P, Campana JP, Dietrich A, et al. Protocol for extended antibiotic therapy after laparoscopic cholecystectomy for acute calculous cholecystitis (Cholecystectomy Antibiotic Randomised Trial, CHART). BMJ Open. 2015;5:109-15. doi: 10.1016/j.surg.2018.
Regimbeau JM, Fuks D, Pautrat K, et al. Effect of postoperative antibiotic administration on postoperative infection following cholecystectomy for acute calculous cholecystitis: a randomized clinical trial. JAMA. 2014;312:145-54. doi: 10.1001/jama.2014.7586.
Harboe K, Bardram L. Nationwide quality improvement of cholecystectomy: results from a national database. Int J Qual Health Care. 2011;23(5):565-73. doi: 10.1093/intqhc/mzr041.
Ansaloni L, Pisano M, CoccoliniF, Peitzmann AB, Fingerhut A, Catena F, Agresta F, et al. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg. 2016;11(1):25. doi: 10.1186/s13017-016-0082-5.
Sandblom G, Videhult P, Crona GY, Svenner A, Sadr-Azodi O. Mortality after a cholecystectomy: a population-based study. HPB (Oxford). 2014;17(3):239-43. doi: 10.1111/hpb.12356.
Carvalho RWF, Pereira CU, Laureano Filho JR, Vasconcelos BCE. O paciente cirúrgico parte II. Rev Cir Traumatol Bucomaxilofasc. 2011;11(4):9-12.
Schwartz DA, Shah AA, Zogg CK et al. Operative delay to laparoscopic cholecystectomy: Racking up the cost of health care. J Trauma Acute Care Surg. 2015;79:15-21. doi: 10.1097/TA.0000000000000699.
