Bleeding complications in cholecystectomy: a register study of over 22,000 cholecystectomies in Finland.

S Suuronen,A Kivivuori,H Paajanen,J Tuimala

doi:10.1186/s12893-015-0085-2

Abstract

BackgroundMajor bleeding is rare but among the most serious complications of laparoscopic surgery. Still very little is known on bleeding complications and related blood component use in laparoscopic cholecystectomy (LC). The aim of this study is to compare bleeding complications, transfusion rates and related costs between LC and open cholecystectomy (OC).MethodsData concerning LCs and OCs and related blood component use between 2002 and 2007 were collected from existing computerized medical records (Finnish Red Cross Register) of ten Finnish hospital districts.ResultsRegister data included 17175 LCs and 4942 OCs. In the LC group, 1.3 % of the patients received red blood cell (RBC) transfusion compared to 13 % of the patients in the OC group (p < 0.001). Similarly, the proportions of patients with platelet (0.1 % vs. 1.2 %, p < 0.001) and fresh frozen plasma (FFP) products (0.5 % vs. 5.8 %) transfusions were respectively higher in the OC group than in the LC group. The mean transfused dose of RBCs, PTLs and FFP product Octaplas® or the mean cost of the transfused blood components did not differ significantly between the LC and OC groups.ConclusionsLaparoscopic cholecystectomy was associated with lower transfusion rates of blood components compared to open surgery. The severity of bleeding complications may not differ substantially between LC and OC.

Highlights

Major bleeding is rare but among the most serious complications of laparoscopic surgery
The mean length of the operation was shorter for laparoscopic cholecystectomy (LC) than for open cholecystectomy (OC)
Intraoperative cholangiographies (IOC) and common bile duct explorations were more common in the OC group

Summary

Introduction

Major bleeding is rare but among the most serious complications of laparoscopic surgery. Still very little is known on bleeding complications and related blood component use in laparoscopic cholecystectomy (LC). The aim of this study is to compare bleeding complications, transfusion rates and related costs between LC and open cholecystectomy (OC). Still, according to register studies, some 10 to 30 % of all cholecystectomies are performed using open technique, in elderly population [7] and in acute cholecystitis [2, 8]. The incidence of bleeding complications requiring transfusion or reoperation has been reported to be relatively rare, occurring in 0.1 % in patients undergoing LC [13]. Regarding OC, only few studies have reported the incidence of bleeding complications in the laparoscopic era. Bleeding has been reported to occur in 0.4 % of patients undergoing OC [4]

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