I. Olorundare1, S. DiBrito1, C. Holscher1, C. Haugen1, D. Segev1 1Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA
Introduction: Patients diagnosed with End Stage Renal Disease (ESRD) are a growing population who are at risk of cholelithiasis and cholecystitis and may require surgical management. Despite this, previous studies of outcomes in this population have been limited by small sample size and a lack of generalizability. We studied outcomes of ESRD patients following cholecystectomy in a large nationally representative database
Methods: We used the Nationwide Inpatient Sample to study 40,765 ESRD and 5.4 million non-ESRD patients who underwent cholecystectomy from 2000-2011. Postoperative complications were defined by ICD-9 codes. Mortality, complication rates, LOS, and hospital costs were compared using hierarchical logistic regression, hierarchical negative binomial regression, and mixed effects log-linear models respectively.
Results:ESRD patients had significantly higher mortality and postoperative complication rates than non-ESRD peers (5.0% vs 0.7%, p<0.001) and (23.1% vs 12.8%, p<0.001) respectively on primary admission. After accounting for patient and hospital level factors, ESRD patients had a greater risk of mortality (OR 4.03, 95% CI 3.08 – 5.26) and postoperative complications (OR 2.42, 95% CI 2.09 – 2.81). In particular, they were at a greater risk of infectious (OR 2.98, 95% CI 2.68 – 3.32), mechanical wound (OR 2.21, 95% CI 1.82 – 2.69), and intraoperative complications (OR 1.53, 95% CI 1.32 – 1.78). Median length of stay (LOS) was longer in ESRD patients (8 vs 3 days, p<0.001) as were median hospital costs ($17169 vs $8762, p<0.001). In adjusted analysis, ESRD patients were at significantly greater risk of extended LOS (RR 1.48, 95% CI 1.45 – 1.50) and higher costs (Ratio 1.36, 95% CI 1.34 – 1.39).
Conclusion:ESRD patients experience higher postoperative mortality, complication rates, hospital costs and an extended length of stay following cholecystectomy when compared to non-ESRD peers. Interventions targeting better control of postoperative wound and infectious complications may allow for improvement in overall outcomes of ESRD patients following cholecystectomy.
