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©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
ARTICLE HIGHLIGHTS
Research background
Symptomatic biliary disorders are common in cystic fibrosis (CF) and may become more common now that patients with CF are living longer. Biliary disorders are often managed with cholecystectomy but this surgery carries high risk of morbidity and mortality among adults with CF. However, the reported rate of complications is based on older studies, and may not represent modern surgical outcomes.
Research motivation
Currently, there is insufficient data examining the safety of cholecystectomy among adults with CF using modern surgical techniques.
Research objectives
To investigate the outcomes of inpatient cholecystectomy among adults with and without CF.
Research methods
The Nationwide Inpatient Sample was used to collect data on inpatient cholecystectomies between 2002 and 2014. Subjects without CF were matched 1:1 to subjects with CF, accounting for over 20 variables including age, sex, and comorbidities.
Research results
Among patients with CF, 1239 cholecystectomies were performed during the study period. Open cholecystectomy was independently associated with an $18449 increase in hospital costs (P = 0.005) and a 4.8 d longer length of stay (P = 0.018) compared to laparoscopic cholecystectomy. The mortality rate among patients with CF was < 0.81%, which was similar to the mortality rate among patients without CF (P = 0.719). Similarly, there was no significant difference in mortality or post-operative surgical complications (4.5% vs 2.3%, P = 0.094) or pulmonary complications (6.6% vs 4.1%, P = 0.109) after laparoscopic cholecystectomy between patients with and without CF in the propensity weighted analysis.
Research conclusions
With modern anesthesia and surgical techniques, cholecystectomy is equally safe for patients with and without CF.
Research perspectives
Cholecystectomy may be increasingly considered for the management of biliary symptoms among adults with CF. Future research will need to clarify if there are unique indications for cholecystectomy among patients with CF.
