Predictive factors and outcomes in patients with gallbladder perforation

Abstract

Introduction. Gallbladder perforation is associated with significant morbidity and mortality. Preoperative diagnosis of perforation is difficult. This study investigates the outcome of patients with gallbladder perforation over a 20-year period and attempts to investigate predictors for perforation. Methods. From 1982 to 2002 all patients undergoing cholecystectomy for gallstone disease were prospectively entered into a database. A subgroup of patients with gallbladder perforation was identified and their outcome was compared with patients presenting with gangrenous cholecystitis. The Chi-square and Student’s t-test were used for statistical analysis where appropriate. Results. 238 patients underwent cholecystectomy for gangrenous cholecystitis. Of those, 30 patients were found to have gallbladder perforation; 9 with contained perforation (pericholecystic abscess) and 21 with free intraabdominal perforation. Gallbladder perforation was suspected in 3% of the patients preoperatively. Men outnumbered the women (23:7) and Hispanics outnumbered the Caucasians (26:4). Postoperative complications in patients with gallbladder perforation correlated with a significantly longer preoperative hospital stay (3.7 versus 0.8 days; P < 0.001). Eight patients underwent an attempted laparoscopic cholecystectomy; six patients (75%) required conversion to the open procedure. Conclusions. Gallbladder perforation is associated with high morbidity and mortality. Longer pre- and postoperative hospital stay, male gender, and advanced age correlated with perforation and postoperative complications in this study. Methods to improve preoperative diagnosis and early treatment are needed to improve the outcome of this disease. TABLE—ABSTRACT P38 Patients w/perf Pat w/o perf P-value Age (yrs) 60 53 <0.05 ASA 2.6 2.3 =0.07 Morbidity (37%) 37 17 <0.05 Mortality (%) 7 1.4 <0.05 Post-op stay (d) 13 8 <0.001