Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2021; 13(9): 371-381
Published online Sep 16, 2021. doi: 10.4253/wjge.v13.i9.371
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
Mitchell L Ramsey, Lindsay A Sobotka, Somashekar G Krishna, Darwin L Conwell, Peter P Stanich, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Alice Hinton, Division of Biostatistics, The Ohio State University College of Public Health, Columbus, OH 43210, United States
Stephen E Kirkby, Division of Pulmonary and Critical Care Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Susan S Li, Division of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Michael P Meara, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Ramsey ML designed and performed the research and wrote the paper; Sobotka LA, Krishna SG designed the research and supervised the report; Hinton A performed the statistical analysis and supervised the report; Kirkby SE, Li SS, Meara MP, Conwell DL supervised the report; Stanich PP designed and performed the research and supervised the report; all authors approved the final version of the article.
Institutional review board statement: As the NIS is a publicly available database of de-identified patients, The Ohio State University Institutional Review Board deemed studies utilizing this resource as exempt.
Informed consent statement: This study was completed using a de-identified dataset, which does not meet criteria for human subject research. Therefore, there is no risk to any individual subject so informed consent is not necessary and was not obtained.
Conflict-of-interest statement: Stanich PP receives research support from Emtora Biosciences, Janssen Pharmaceuticals Inc., Pfizer Inc. and the PTEN Research foundation. Ramsey ML, Sobotka LA, Krishna SG, Hinton A, Kirkby SE, Li SS, Meara MP, Conwell DL has no conflicts of interest to report.
Data sharing statement: The data is available online from the Healthcare Costs and Utilization Project.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Peter P Stanich, MD, Associate Professor, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 W 12
th Ave Second Floor of Faculty Office Tower, Columbus, OH 43210, United States.
peter.stanich@osumc.edu
Received: February 13, 2021
Peer-review started: February 13, 2021
First decision: March 28, 2021
Revised: April 20, 2021
Accepted: August 9, 2021
Article in press: August 9, 2021
Published online: September 16, 2021
Processing time: 208 Days and 17.8 Hours
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.
Core Tip: Cholecystectomy has been considered to be a high-risk intervention in adults with cystic fibrosis (CF). Our study used a sample of adults with closely matched baseline characteristics to compare hospital outcomes among patients with and without CF. There was no difference in mortality or pulmonary or surgical complications between adults with and without CF. Patients with CF who underwent an open cholecystectomy had a longer length of stay than those who underwent a laparoscopic cholecystectomy. This study suggests that cholecystectomy is safe in selected adults with CF and that a laparoscopic approach should be preferred.
