WE2.12 Prognostic Factors and Predictive Models in Hot Gallbladder Surgery. Results of a High-Volume Tertiary Centre

Abstract

Abstract Introduction Gallstone disease is a significant worldwide problem constituting almost one third of emergency general surgery admissions. This study aimed identify the prognostic factors and create statistical models to predict the outcomes of having an emergency laparoscopic cholecystectomy (LC) during the acute symptomatic phase. Methods A prospective, cohort study was conducted on all patients that underwent a LC for a hot gallbladder between January 2019 to August 2020. Patients were divided on prognostic variables such as: age, comorbidities and time to operation. The primary outcome measured was suboptimal treatment, defined by: abandoned procedure, conversion to open and subtotal cholecystectomy. Secondary outcomes measured were biliary leak, postoperative morbidity, readmission rate, and length of postoperative stay. Results A total of 466 patients were included. A multivariate analysis using a backward stepwise linear regression was used to conduct predictive models based on the significant prognostic factors from a univariant analysis. Approximately 10% of patients had suboptimal treatment predicted by age (p<0.0001) and low albumin (p=0.0034). 17.2% of patients had post-operative morbidity predicted by age (p=0.0201), admission day (p=0.0238), and male gender (p=0.0481). 20.8% of patients were re-admitted, predicted by an ASA >3 (p=0.0096), thin-walled gallbladder (p=0.0491) and greater admission to operation time (p=0.0351). Post-operative length of stay was predicted by age (p=0.0048), low albumin (p=0.0048) and greater admission to operation time (p=0.0169). Conclusion Several predictive prognostic factors were found to be related to poor emergency LC outcomes which can be used to inform patients of risks pre-operatively and select patients suitable for a delayed cholecystectomy.