J. Imran1, A. Ochoa-Hernandez3, J. Herrejon1, S. Huerta1,2 1University Of Texas Southwestern Medical Center,Surgery,Dallas, TX, USA 2VA North Texas Health Care System,Surgery,Dallas, TX, USA 3Hospital Nacional De San Benito,Surgery,San Benito, EL PETEN, Guatemala
Introduction:
While laparoscopic cholecystectomy (LC) is the standard of care in the Western world, many third world countries still perform a number of open cholecystectomies (OC). We analyzed the outcomes of all patients undergoing cholecystectomy at a referral hospital in El Peten, Guatemala (Hospital Nacional de San Benito: HNSB). Our null hypothesis was that we would find no difference in outcomes between LC and OC.
Methods:
This a retrospective, single-institution study at HNSB between January 2014 to April 2016 in all consecutive patients who underwent a cholecystectomy during this time period. Differences between LC and OC were analyzed by univariate analysis [(UA): Fisher’s Exact Test for categorical variables and Student’s T-Test for continuous variables]. Clinically relevant factors and those with a p≤0.2 were entered in a logistic regression model with complications and operative time as the dependent variables. The data is expressed as a means±SD. Significance was established at a p≤0.05 (two-sided).
Results:
One hundred consecutive charts were reviewed and used in our analysis. 58% of the cholecystectomies were performed via the open technique and 42% using the laparoscopic approach. There were 42% emergent and 58% elective cholecystectomies. Of the cholecystectomies performed in the elective setting, 47 % were done open. Conversion rate, hospital length of stay (LOS) and re-admission rate was 4%, 4.8 days and 5% respectively. There were no SSIs, UTIs or pneumonia in this cohort; 30d and 90d mortality was 0%. Patients who underwent OC vs. LC were of similar age (36.2±16.3 vs. 37.4 ± 16.1 yo; p=0.7), female gender (79% vs. 88% p=0.27), and ASA class (1.2 ± 0.69 vs. 1.36±0.81; p=0.3). Patients undergoing OC had higher average weight (164.5 ± 27.2 vs. 145 ±42.9 lbs; p=0.03). Patients with biliary colic were more likely to undergo OC (79% vs. 51%; p=0.001) in comparison to patients with acute cholecystitis who were more likely to undergo LC (36% vs. 14%; p=0.02). At presentation, patients undergoing LC had a higher mean temperature in comparison to OC (37.1 ± 0.24 vs. 36.9 ± 0.15; p=0.02), but had similar WBC count (10.3±5.0 vs. 9.1±3.1; p=0.2). There was no difference in operative time between patients undergoing OC and LC (65.3±20.6 vs. 61.6±31.0 min; p=0.5). LOS was similar (4.9±5.4 vs. 4.8 ± 3.9 d; p=0.8), as was readmission rate (7.5% vs. 3.7%; p=0.6). Logistic regression analysis did not identify any independent predictors of outcomes.
Conclusion:
For this study, we accepted the null hypothesis. However, we cannot exclude a type II error. Nearly half of the open cholecystectomies performed during the study period were done in the elective setting. This finding could be further explored as a potential route to train our surgical residents in open cholecystectomy though the creation of a residency exchange program.