S. Taghavi1, S. Jayarajan1, V. Ambur1, J. Gaughan1, Y. Toyoda1, E. Dauer1, L. Sjoholm1, A. Pathak1, T. Santora1, A. Goldberg1, J. Rappold1 1Temple University School Of Medicine,Department Of Surgery,Philadelphia, PA, USA
Introduction: Lung transplantation remains the treatment of choice in select patients with end-stage pulmonary disease. There is a paucity of data on outcomes for lung transplant recipients requiring general surgery procedures. The goal of this study was to examine outcomes after cholecystectomy in lung transplant patients using a large, national database.
Methods: The National Inpatient Sample (NIS) Database (2005-2010) was queried for all lung transplant patients requiring laparoscopic cholecystectomy, open cholecystectomy, and tube cholecystostomy. Weighted frequencies were used to examine peri-operative outcomes.
Results: There were a total of 387 cholecystectomies or cholecystostomies performed in lung transplant patients during the study period. The majority were done for acute cholecystitis (n=218, 56.9%) and were done urgently/emergently (n=258, 68.2%). There were a total of 304 (78.6%) laparoscopic cholecystectomies, 73 (19.1%) open cholecystectomies, and 10 (2.6%) tube cholecystostomies. Elective admission occurred more often in the laparoscopic cholecystectomy group (n=114, 37.5%) as compared to the open cholecystectomy (n=15, 20.5%) and cholecystostomy (n=0, 0.0%) groups; p=0.002. There was no significant difference in age when comparing the laparoscopic cholecystectomy (53.6 years), open cholecystectomy (55.5 years), and cholecystostomy (62.5 years) groups; p=0.39. In addition, Charlson Comorbidity Index was similar in the laparoscopic cholecystectomy (2.69), open cholecystectomy (3.49), and cholecystostomy (3.47) groups; p=0.52. Patients undergoing open cholecystectomy were more likely to have perioperative myocardial infarction, pulmonary embolus, or any complication compared to laparoscopic cholecystectomy or tube cholecystostomy (table). Total hospital charges ($59,137.00 vs. $106,329.80; p=0.03) and median length of stay (4.0 vs. 8.0 days; p=0.02) were significantly higher and longer with open cholecystectomy compared to the laparoscopic procedure. Patients having urgent/emergent surgery were more likely to suffer pulmonary embolus (3.5% vs. 0.0%, p=0.03) or any complication (9.3% vs. 3.9%, p=0.05) than patients having elective surgery.
Conclusion: Cholecystectomy can be performed in the lung transplant population with minimal morbidity and mortality. Patients requiring open surgery and emergency procedures appear to have worse outcomes. Strong consideration should be given to elective, laparoscopic cholecystectomy in lung transplant patients with symptomatic gallstone disease.
