86.01 Laproscopic Cholecystectomy In The Acute Care Surgery Model: Risk Factors And Complications

Posted on January 26, 2017

E. Sweet1, E. Seabold1, K. Herzing1, R. Markert1, A. Gans1, A. Ekeh1  1Wright State University,Surgery,Dayton, OH, USA

Introduction:
The Acute Care Surgery (ACS) model has been widely popularized over the last decade – fusing the care of Trauma and Emergency General Surgery patients. Laparoscopic Cholecystectomies (LC) are commonly performed by ACS teams typically for acute indications admitted from the Emergency Department. We reviewed LCs performed by an ACS service with > 3000 Trauma annual admissions, focusing on outcomes and risk factors for complications in the emergent setting.

Methods:
All patients who underwent LC on our ACS service over a 26 month period (Jan 2014-Feb 2016) were identified. Data including demographic data, BMI, indications for surgery, time of day of surgery (am or pm), surgeon years of experience, rate of conversion to open, bile leaks, major biliary injury and other complications were collected. Risk factors for complications were analyzed using Chi-squared and Mann-U Whitney tests.

Results:
There were 547 patients who had LC in the studied period (70.2% female, mean age 46 years, meanBMI 32.4 kg/m2) performed by 11 surgeons. Indications for surgery included Acute Cholecystitis(46.8%), Symptomatic Cholelithiasis (25.2%) and Gallstone pancreatitis (6.6%) Mean surgery time was 79±50 mins and 5.7% of cases were performed "after hours." Conversion to open rate was 6%. Minor bile leaks were present in 3.8%, retained stones in 1.1%, post-op bleeding in 1.1% and major duct injury in 0.9%. Statistical analysis did not identify any risk factors for bile leaks, majorbiliary injury or other complications.

Conclusion:
ACS services are capable of performing a high volume of LCs with low complication and conversion to open rates. The majority of LCs were for emergent indications. No correlations between complications and patient age, gender, BMI, indications for surgery, surgeon experience or time of day of operation were found. The ACS model is well suited to address needs of patients acute biliary disease.