Outcomes of Cholecystectomy in US Heart Transplant Recipients

Abstract

The aim of this study was to evaluate outcomes and predictors of in-hospital mortality after cholecystectomy in heart transplant (HTx) recipients. There is a paucity of data on outcomes after cholecystectomy in HTx recipients. The Nationwide Inpatient Sample (NIS) database was used to identify HTx recipients who underwent cholecystectomy between 1998 and 2008. Multivariate logistic regression analysis was constructed using clinically relevant covariates (age, gender, Charlson comorbidity index, race, admission acuity, complicated gallstone disease, hospital teaching status, and open versus laparoscopic approach) to identify predictors of in-hospital mortality. A total of 1687 HTx recipients underwent cholecystectomy (open n = 420; laparoscopic n = 1267) during the study period. Mean age was 57.1 ± 12.5 years, and there were 1230 (72.9%) males. The majority of patients had acute cholecystitis (n = 1218; 72.2%) and were admitted urgently/emergently (n = 1028; 60.9%). Overall inpatient mortality occurred in 37 (2.2%) patients, with a higher mortality rate in open cholecystectomy compared with laparoscopic (6.2% vs. 0.9%; P = 0.009), and in urgent/emergent versus elective cases (3.6% vs. 0%; P = 0.04). Open or urgent/emergent cholecystectomies also had higher overall complication and respiratory failure rates as compared with laparoscopic or elective cases. Predictors of inpatient mortality in multivariable analysis included urgent/emergent admission, open cholecystectomy, and complicated gallstone disease (each P < 0.05). This is the largest reported study to date of cholecystectomy in HTx recipients. HTx patients appear to be at increased risk of inpatient mortality and morbidity after cholecystectomy as compared with the general population, and this rate is particularly high in those with a nonelective admission who undergo open cholecystectomy for complicated gallstone disease. Therefore, strong consideration should be given to prophylactic cholecystectomy in HTx recipients with asymptomatic and uncomplicated gallstone disease.