Longer Hospital Stay, but No Greater Death Risk, in Gallbladder Surgery
Despite longer hospital stays and higher costs, adults with cystic fibrosis (CF) do not have a greater risk of death from surgery to remove the gallbladder — called a cholecystectomy — compared with people who do not have CF, a study reported.
“Importantly, we found that cholecystectomy had very low in-hospital mortality that was not significantly different from the general population,” the scientists wrote.
However, the total hospital charges for such surgery for CF patients were about $10,000 more than the overall costs for people without the genetic disorder who underwent the procedure. And those with CF also stayed in the hospital an average of four days longer than those in the general population.
“These results should inform the discussion between clinicians and patients with CF when cholecystectomy is considered,” the researchers wrote.
The study, “Outcomes of inpatient cholecystectomy among adults with cystic fibrosis in the United States,” was published in the World Journal of Gastrointestinal Endoscopies.
Patients with CF often experience biliary and gallbladder disorders due to the high expression (levels) of CFTR — the protein whose mutations cause CF. The high prevalence of gallstones in this patient population may be due in part to the prolonged transport of bile through the biliary ducts. Along with the increasing use of CFTR modulators, reports of higher prevalence of gallstones as patients age indicate that biliary and gallbladder disorders are becoming more frequent.
These disorders may ultimately require removal of the gallbladder, a small organ under the liver responsible for bile secretions in the digestive tract. Gallbladder removal surgery in the general population is now the most common elective abdominal surgery performed in the U.S., according to research from 2012, which noted that more than 750,000 operations were being done annually in the country.
But concerns over surgical complications, and reports of higher mortality compared with the general population, have made this approach rare in those with CF.
However, a team of researchers from The Ohio State University Wexner Medical Center noted here that the surgical case series focusing on cholecystectomy in CF was completed more than 25 years ago, before the advent of new, less-invasive technologies now available. The researchers hypothesized that these recent surgical techniques, and changing patient characteristics, make the outcomes of this surgery similar in CF patients and the general population.
To test this theory, the team performed a retrospective analysis using the Nationwide Inpatient Sample (NIS) from 2002 to 2014. The NIS is one of the largest publicly available databases in the U.S. with data from more than 35 million hospitalizations annually.
This study included 5,976,224 adults who underwent cholecystectomy, 1,239 of whom had CF.
The CF patients were younger thank those without the disease (mean age 31.3 vs. 53.8), and more likely to be white (90.9% vs. 68.2%), have private insurance (52.2% vs. 42.8%), receive treatment at an urban teaching hospital (74.8% vs. 41.1%), and have chronic respiratory failure (1.96% vs. 0.27%).
The surgery indications between people with CF and those without also were different. Patients with CF were more likely to have gallstone disease without gallbladder swelling and have motility impairment in the biliary, but were less likely to undergo surgery for acute gallbladder swelling.
Ultimately, mortality associated with the surgeries was not significantly different between patients with or without CF. In fact, rates were less than 1% in each group.
However, those with CF had longer hospital stays and higher hospital costs. They also underwent a laparoscopic surgery — a minimally invasive approach to access the abdominal area — more often. Analysis of patients who underwent this type of surgery showed a higher mean length of hospital stay (9.4 days vs. 5.2 days) and total hospital costs ($25,891 vs. $14,103).
The scientists noted that previous research — in cases involving sinus surgeries — indicated that longer hospital stays for CF patients are not the result of complications but instead of extended monitoring and intravenous (into-the-vein) antibiotics. “Our study shows this also appears to be true for cholecystectomy,” the investigators wrote.
The rates of post-surgery complications and pulmonary complications were not significantly different between the CF and non-CF groups.
Among the patients with CF, 973 (78.6%) underwent laparoscopic surgery. Compared with the group that underwent open surgery, the laparoscopic patients were more likely to be female, and had shorter hospital stays (8.9 days vs. 14.5 days) and greater hospital costs ($23,288 vs. $43,024). Notably, there was no difference in mortality between these two groups.
“Among patients with CF, laparoscopic approach reduces resource utilization and minimizes post-operative complications,” the team wrote.
As for study limitations, the scientists noted that they were not able to account for characteristics such as medication use, nutritional status, and pulmonary function.