Open Cholecystectomy Patients Research Articles

Comparative Risk of Surgical Site Infection With Open Cholecystectomy Vs Laparoscopic Cholecystectomy

OBJECTIVES: This study aimed to compare the risk of surgical site infection with open vs laparoscopic cholecystectomy. METHODOLOGY: This randomized control trial was done at the Department of Surgery, Hayatabad Medical Complex, Peshawar, for 12 months from 11/5/2018 to 11/5/2019. 116 patients were recruited for this study, 58 for each group randomly allocated to a group by lottery method and concealed Allocation. Patients in Group A underwent laparoscopic cholecystectomy, while patients in group B underwent open cholecystectomy. According to ward protocol, post-operative analgesia & antibiotics were given to patients in both groups. Expert consultant general surgeons did all the evaluation & procedures; all the patients were followed up to 30 days after the procedure & any surgical site infections, if found, were noted. RESULTS: The mean age was 36 years ± 12.19 SD and 38 years ± 11.88 SD in laparoscopic and open cholecystectomy, respectively. In laparoscopic cholecystectomy, 28% of patients were male, and 72% of patients were female, while in open cholecystectomy, 29% of patients were male, and 71% of patients were female. 07% of laparoscopic and 26% of open cholecystectomy patients had surgical site infections. CONCLUSION: Our study concludes that the frequency of surgical site infection was found less in laparoscopic cholecystectomy than in open cholecystectomy.

Clinical outcome of subtotal cholecystectomy for difficult gallbladder

When the Calot triangle structures cannot be found and a critical evaluation of patient safety cannot be achieved, surgeons perform a subtotal cholecystectomy (SC). objective Evaluation and analysis of the outcomes of subtotal cholecystectomy at the GIT and Hepatology teaching Hospital is to be conducted. Retrospective analysis of patient data and research methodologies thirteen hundred and eighty onsecutive cholecystectomy patients at GIT & Hepatology Hospital (Oct.2017 to Apr.2020). 53 of the 1380 people investigated underwent a partial cholecystectomy. Routine laparoscopic or open cholecystectomy patients (13.27) could not be included in the study. An individual patient's medical history is mined for information on their preoperative features. Results 53 individuals had subtotal cholecystectomy, with 29 males (55.7%) and 24 women (24.8%) both undergoing the procedure (45.2 percent ). Patients in the research, who ranged in age from 20 to 69, had an average age of 43.5 years. The bulk of the 45 patients (87.2%) had elective surgery, whereas only 8 (15%) had emergency surgery. There were 33 cases of laparoscopic subtotal cholecystectomy and only 20 cases of open subtotal cholecystectomy in this study (6 patients had conversion subtotal cholecystectomy).

A Comparative Analysis between Laparoscopic and Open Cholecystectomy at a Tertiary Care Hospital in Patients with Acute Cholecystitis

Background: Acute cholecystitis is clinically characterized as an episode of acute biliary pain; fever and right hypochondrial tenderness with symptoms persistence exceeding 24 hours. Aims & Objectives: We compared and analyzed open and laparoscopic cholecystectomy in the current study on the basis of the duration of the operation, intra and postoperative complications and the length of hospital stay & return to work.Material and Methods: This was a prospective comparative, randomized hospital-based study performed in patients of 20 - 80 years of age with acute cholecystitis in the Department of General Surgery from July 2019 to January 2021 at SMH&RC, Datta Meghe Medical College Nagpur. Patients were divided randomly into two classes as Open cholecystectomy (60 patients) and laparoscopic cholecystectomy (60 patients). The key assessed outcome was death, peri-operative & post-operative complications; length of hospital stay and wound infection, return to work. The gathered data was statistically analyzed. Results: In both categories, the most common age group was 40-59 years old. The female population (78%) was greater than the male population (22 percent). 1: 3.6 was the male to female ratio. The mean time needed for open cholecystectomy was 53.18 ± 12.74 minutes, while 38.37 ± 6.21 minutes for laparoscopic cholecystectomy, and the difference was statistically important. 2 (3.3 percent) laparoscopic procedures involved conversion to open surgery due to difficult dissection, bleeding & blurred vision. In terms of postoperative pain (VAS > 4), hospital stay period and return to work, laparoscopic cholecystectomy had better outcomes than open cholecystectomy and the difference was statistically important. In Open Cholecystectomy patients, wound infection, post-operative paralytic ileus was substantially greater. There were 2 patients with wound dehiscence from open cholecystectomy. No significant morbidity or any mortality during the study period was reported.Conclusion: Laparoscopic cholecystectomy provides decisive advantages over open cholecystectomy in acute cholecystitis (e.g. shorter time of surgery, fewer post-operative complications, less paralytic ileus, less analgesic use, early discharge and mobilization).

Effect of CO2 Pneumoperitoneum on Liver Function Following Laparoscopic Cholecystectomy

Background: Laparoscopic provides access to abdominal cavity for both diagnostic and therapeutic surgical interventions which were previously only possible through laparotomy. Recent studies have shown marked rise in serum liver enzymes after laparoscopic surgeries which is considered to be related to the impaired liver and splanchnic perfusion. The present study has been carried out with the aim to comprehend changes in liver enzymes after laparoscopic vs conventional cholecystectomy and the effects of these on outcomes of surgery. Subjects and Methods: Between January 2018 and June 2019, 100 patients with symptomatic gall stones which were eligible for cholecystectomy were enrolled in this prospective clinical observational trial. Randomisation to laparoscopic or open cholecystectomy was performed by using a sealed envelope technique just before surgery. All cases were operated by the same consultant surgeon with a standard anaesthetic protocol. Liver function tests were performed before surgery, at 24 hours and day seven postoperatively. Results: In the laparoscopic group, a statistically significant rise in liver enzymes both aspartate aminotransferase and alanine aminotransferase was observed after 24 hrs of surgery as compared to preoperative values (p<.001) and then again touching normal serum level on 7th day postoperatively. Whereas in open cholecystectomy patients, only a slight variation in the liver enzymes was observed, which was not significant compared to preoperative level (p>.05). No statistically significant changes in serum level of GGT, ALP and bilirubin was seen in either group. No mortality or bile duct injury was observed in this study. Conclusion: Transient elevation in level of liver enzymes occurs after cholecystectomy in both open and laparoscopy group but more in laparoscopic arm attributed to CO2 pneumoperitoneum with possibly some other factors contributing to this. These changes return to normal in a week time after the procedure, and no major complication is generally seen in these patients with normal preoperative liver function, but these temporary derangements at times may be of concern to surgeons for its implication to the integrity of biliary tract.

Evaluation of pre and post operative status of hepatic and renal function conditions in open cholecystectomy patients

Evaluation of pre and post operative status of hepatic and renal function conditions in open cholecystectomy patients

Subcostal TAP block as analgesic for open cholecystectomy

Open Cholecystectomy, is associated with high pain score post op.TAP block provides effective post op analgesiaAimThe aim is to evaluate the effectiveness of US guided subcostal TAP block for post op pain in open cholecystectomyPatients were divided into two groups. Thirty patients received subcostal TAP block after commencing GA. Another thirty patients did not receive the block.Post operative pain was recorded in both groups , so as any possible complications like nausea and vomiting .We found that subcostal TAP block is effective , simple , and reliable as analgesia in open cholecystectomy post operativelyPatients and MethodsA total of 60 patients undergoing emergency and elective cholecystectomy were allocated into two groups : U/S guided subcostal TAP block , the A group , and the non TAP block group , the B group. All patients received same general anaesthesia drugs and technique.The A group received subcostal TAP block 5 minutes before starting surgery , a total of 20 ml , 10 ml 1% lidocaine and 10 ml 0,25% bupivacaine Rescue post op analgesia was in the form of I.V tramal and diclofenac.Pain score was recorded post op , using VAS ( Visual Analogue Score ).
 ResultsGroup A ( 30 patients ) , received subcostal TAP block 5 minutes prior to starting surgery , and Group B ( 30 patients ) did not received TAP block. Post op pain score recorded in both groups , and showed pain score 0-2 in group A , and 6-8 in group B which received rescue analgesiaConclusionSubcostal TAP block is effective analgesic technique with opioid –sparing effect in open cholecystectomy post operatively

Does Gabapentin Relieve Acute Preoperative Anxiety?

INTRODUCTION: The role of Gabapentin in relieving chronic pain, chronic anxiety disorders and acute postoperative pain is well known by now. Trials done with the administration of Gabapentin to treat preoperative anxiety showed mixed results. So, this study was conducted to test the hypothesis that premedication with Gabapentin 1200 mg versus placebo would reduce preoperative anxiety in patients undergoing open cholecystectomy under general anesthesia. MATERIAL AND METHODS: A prospective, randomized, double blind and placebo controlled study was carried out at Universal College of Medical Sciences & Teaching Hospital (UCMSTH) from August 2012 to Januray 2014. Total 160 adult patients of American Society of Anaesthesiologist (ASA) I and II were divided into 2 groups of 80 each. Patients in group 1 and group 2 received capsules Gabapentin (1200mg) or identical placebo capsules 2 hours prior to surgery respectively. Preoperative anxiety was assessed for three times using Anxiety Visual Analogue Scale (VAS) score. A uniform anesthetic technique was used in both groups. Parameters including preoperative and postoperative sedation scores and various side effects were also observed.RESULTS: VAS anxiety scores after one hour of drug intake (47.19±17.37 versus 63.13±17.77) and just before induction of anaesthesia (43.81±17.72 versus 81.81±21.57) were significantly lower in Gabapentin group as compared to placebo group. No patient experienced any significant side effects or sedation in either group throughout the study period.CONCLUSIONS: Premedication with 1200 mg Gabapentin in open cholecystectomy patients significantly reduced preoperative anxiety as evident by decrease in anxiety VAS scores without any significant side effects. DOI: http://dx.doi.org/10.3126/jucms.v2i3.11821 Journal of Universal College of Medical Sciences Vol.2(3) 2014: 9-14

Effect of gabapentin premedication on preoperative anxiety and postoperative pain

Background: In addition to chronic pain and anxiety disorders, few studies have found promising role of gabapentin in relieving acute postoperative pain as well as acute anxiety too. Objectives: To evaluate the effect of gabapentin premedication on preoperative anxiety and postoperative pain in patients undergoing elective open cholecystectomy. Methods: A prospective, randomized, double blind and placebo controlled study. Eighty adult patients of ASA I and II were divided into 2 groups of 40 each. Patients in group 1 and group 2 received capsules Gabapentin (1200mg) or identical placebo capsules 2 hours prior to surgery respectively. Preoperative anxiety and 12 hours postoperative pain was assessed using Anxiety and Pain VAS score respectively along with the observation of side effects. Postoperatively, intravenous pethidine 0.5 mg/kg was given when pain VAS > 40mm and time to first pethidine injection and total pethidine consumption in 12 hours was recorded. Results: Anxiety VAS scores after one hour of drug intake (35.75±20.11 versus 46.63±12.73) and just before induction of anaesthesia (45.75±30.27versus 68.13±29.84) along with postoperative Pain VAS scores were significantly lower in gabapentin group. Time to the first pethidine demand was significantly longer (145.34±194.54 min versus 26.30±51.02min) and cumulative pethidine consumption throughout study period was also significantly lower (35.91 ± 16.61 versus 57.84 ± 20.72mg) in gabapentin group. Conclusions: 1200 mg gabapentin premedication in open cholecystectomy patients significantly reduced preoperative anxiety, postoperative pain and total pethidine consumption with negligible side effects. DOI: http://dx.doi.org/10.3126/hren.v11i3.9642 Health Renaissance 2013;11(3):254-259

Assessment of nurses' knowledge and practice regarding postoperative open cholecystectomy patients at Assiut university hospital

Cholecystectomy is the surgical removal of the gallbladder. Surgical options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy. Approximately 700,000 cholecystectomies are performed annually in the United States. The Aim of the study is to assess nurses' knowledge and practice regarding postoperative open cholecystectomy patients. Descriptive research design was utilized in this study .This study was conducted in the general surgery department at Assiut University Hospital. A convenient sample of 60 nurses was included in this study. Data collected by utilizing the designed interview questionnaire sheet consists of biosocial characteristics of nurses and assessment of nurses' knowledge, observation checklist sheet. The results can be concluded that more than half of nurses (81.7%) had poor level of knowledge regarding nursing care of open cholecystectomy. All nurses (100%) had an inadequate level of practice regarding nursing care for patients post open cholecystectomy. It was found that there was a positive relationship between total knowledge score and total practice score. Conclusion: it can be concluded that, Nurses` knowledge and practice regarding nursing care of patient post cholecystectomy are at a poor and inadequate level and need developing nursing care standards to improve nurses` knowledge and practice.

Assessment of nurses' knowledge and practice regarding postoperative open cholecystectomy patients at Assiut university hospital

Abstract: Cholecystectomy is the surgical removal of the gallbladder. Surgical options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy. Approximately 700,000 cholecystectomies are performed annually in the United States. The Aim of the study is to assess nurses' knowledge and practice regarding postoperative open cholecystectomy patients. Descriptive research design was utilized in this study .This study was conducted in the general surgery department at Assiut University Hospital. A convenient sample of 60 nurses was included in this study. Data collected by utilizing the designed interview questionnaire sheet consists of biosocial characteristics of nurses and assessment of nurses' knowledge, observation checklist sheet. The results can be concluded that more than half of nurses (81.7%) had poor level of knowledge regarding nursing care of open cholecystectomy. All nurses (100%) had an inadequate level of practice regarding nursing care for patients post open cholecystectomy. It was found that there was a positive relationship between total knowledge score and total practice score. Conclusion: it can be concluded that, Nurses` knowledge and practice regarding nursing care of patient post cholecystectomy are at a poor and inadequate level and need developing nursing care standards to improve nurses` knowledge and practice.

The use of laparoscopic ultrasound in difficult cholecystectomy cases significantly decreases morbidity

Laparoscopic ultrasound (LUS) is a method of intraoperative bile duct imaging that can be used prior to any potentially hazardous dissection. The purpose of this study was to determine whether LUS could permit safe laparoscopic completion of difficult cholecystectomy (LC) cases and to assess whether its use had any impact on clinical outcome. We identified prospectively 44 patients with severe cholecystitis in whom LUS was considered critical for intraoperative identification of the bile ducts. LC patients were compared, on an intention to treat basis, with 41 contemporaneous patients with severe cholecystitis who had planned open cholecystectomy (OC). LUS identified the extrahepatic bile ducts in all cases. Of the cases, 40 (91%) were completed laparoscopically. OC patients had a higher rate of acute cholecystitis and preoperative percutaneous cholecystostomy tubes and a higher mean ASA classification. Intraoperatively, LC patients had significantly less estimated blood loss and fewer drains were placed. Postoperatively, LC patients had significantly fewer total complications, Clavien-Dindo grade 3 complications, biliary complications, biliary reinterventions, intra-abdominal abscesses, and bleeding complications. LC patients had significantly fewer ICU admissions and shorter LOS. By allowing identification of the extrahepatic bile ducts during difficult cholecystectomy, LUS results in a high rate of successful laparoscopic completions. Laparoscopic cholecystectomy is associated with better clinical outcomes than OC for patients with severe cholecystitis.

Health-related quality of life in patients undergoing cholecystectomy

This large-scale prospective cohort study of a Taiwan population applied generalized estimating equations to evaluate predictors of health-related quality of life (HRQOL) after open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) procedures performed between February 2007 and November 2008. The Gastrointestinal Quality of Life Index and Short Form-36 were used in a preoperative assessment and in 3 rd month and 6 th month postoperative assessments of 38 OC and 259 LC patients. The HRQOL of the cholecystectomy patients were significantly improved at 3 months and 6 months postsurgery ( p < 0.05). At 3 months postsurgery, HRQOL improvement was significantly larger in LC patients than in OC patients. Patient characteristics, clinical characteristics, and health care quality were also significantly related to HRQOL improvement ( p < 0.05). Additionally, after controlling for related variables, preoperative health status was significantly and positively associated with each subscale of the Gastrointestinal Quality of Life Index and Short Form-36 throughout the 6 months ( p < 0.05). Patients should be advised that their postoperative HRQOL may depend not only on their postoperative health care but also on their preoperative functional status.

Relationships of age, cholecystectomy approach and timing with the surgical and functional outcomes of elderly patients with cholecystitis

Background Safety confirmation has led to calls for laparoscopic cholecystectomy (LC) to prevail in elderly patients, but the functional changes after LC have not been sufficiently compared with open cholecystectomy (OC). Using an administrative database, we reassessed the quality of cholecystectomy approach and timing of cholecystectomy for elderly patients with cholecystitis. Methods A total of 2552 patients aged ≥60 years who underwent cholecystectomy for cholecystitis were enrolled. Variables included demographics, comorbidities, complications, preoperative bile duct scrutiny, cholecystectomy timing (<48, 48–96, >96 h), functional status estimated by the Barthel index, teaching status, postoperative length of stay (LOS) and total charges (TC). The impacts of age, OC and timing on LOS, TC, complications and functional changes were assessed by mixed linear regression analyses using propensity score-matched cohorts for LC and OC. Results The patients comprised 1742 LC and 810 OC patients across 122 hospitals. The mean ages and octogenarian proportions were 70.1 years and 10.6% for LC and 72.9 years and 20.5% for OC. Advancing age, males and acute inflammation were more frequently associated with OC. Longer LOS, higher TC and more complications were observed for OC. Age was a predictor of functional changes but not complications. Octogenarians and complications were associated with longer LOS, higher TC and more functional deterioration. Earlier cholecystectomy was only associated with lower TC. Conclusions Octogenarians were likely to have OC and functional deterioration. Since OC was a predictor of resource use and complications, strategies to complete earlier LC and prevent complications are required for octogenarians.

Changing Approaches to Cholecystectomy in Elderly Patients: A 10‐Year Retrospective Study in Taiwan

The prevalence of symptomatic gallbladder diseases increases with age. The present study evaluated cholecystectomy risk factors and hospital resource utilization in an elderly (aged 60years and older) population of patients who had undergone open cholecystectomy (OC) or laparoscopic cholecystectomy (LC). The study analyzed 20,538 OC and 29,318 LC procedures performed in Taiwan from 1996 to 2007. Odds ratio (OR) and 95% confidence interval were calculated to assess the relative change rate. Regression models were employed to predict length of stay (LOS) and total surgical cost. Patient characteristics associated with increased likelihood of undergoing LC were age 60-69years, female gender, and lack of current co-morbidities. Length of stay associated with both OC and LC decreased during the study period. Total surgical cost for elderly OC patients increased during the study period, whereas that for elderly LC patients declined. Compared to OC patients, LC patients had significantly larger changes in LOS (-2.27days) and total surgical cost ($ -368.64 U.S. dollars) (p<0.001). The following factors were associated with considerable increases in both LOS and total surgical cost: advanced age, female gender, presence of one or more co-morbidities, treatment in a regional or a district hospital, and long LOS. Decreases in hospital resource utilization were larger in elderly LC patients than in elderly OC patients. Health care providers and patients should observe that hospital resource utilization may depend on hospital attributes as well as patient attributes. These analytical results should be applicable to similar elderly populations in other countries.

A Current Profile and Assessment of North American Cholecystectomy: Results from the American College of Surgeons National Surgical Quality Improvement Program

Cholecystectomy is among the most common surgical procedures performed in the United States. The current state of cholecystectomy outcomes, including variations in hospital performance, is unclear. The objective of this study is to compare the risk factors, indications, and 30-day outcomes, as well as variations in hospital performance associated with laparoscopic (LC) versus open cholecystectomy (OC) at 221 hospitals during a 4-year period. Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2005-2008), patients were identified who underwent cholecystectomy and related procedures (cholangiogram and/or common bile duct exploration). Four outcomes were studied, ie, 30-day overall morbidity, serious morbidity, surgical site infections, and mortality. Forward stepwise logistic regressions yielded patient-level predicted probabilities, and hospital-level observed-to-expected ratios were determined. Of 65,511 patients, 58,659 (89.5%) underwent LC; 6,852 (10.5%) underwent OC. OC patients were considerably older with a higher comorbidity burden. LC patients were less likely to experience any morbidity (3.1% versus 17.8%; p < 0.0001), a serious morbidity (1.4% versus 11.1%; p < 0.0001), or a surgical site infection (1.3% versus 8.4%; p < 0.0001), and less likely to die (0.3% versus 2.8%; p < 0.0001). Observed-to-expected ratios for overall morbidity ranged from 0 to 3.55; for serious morbidity, 0 to 3.23; for surgical site infection, 0 to 7.02; for mortality, 0 to 13.05. Although overall incidence of adverse events is low after LC, substantial morbidity and mortality are associated with OC. Additionally, controlling for patient- and operation-related factors, considerable variations exist in hospital performance when evaluating 30-day outcomes after cholecystectomy.

Cholecystectomy prevalence and treatment cost: an 8-year study in Taiwan

This study characterized the prevalence and treatment costs of laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) procedures performed for a population-based patient cohort. This study analyzed 32,535 OC and 80,335 LC procedures performed in Taiwan from 1996 to 2004. The odds ratio (OR) and effect size were calculated to assess the relative change rate. Bootstrap estimation was used to derive 95% confidence intervals (CIs) for differences in effect sizes of LC and OC. Multiple regression models were used to predict total treatment cost. The prevalences of OC and LC were respectively 18.19 and 25.44 per 100,000 persons in 1996. In 2004, OC gradually decreased to 13.21, but LC dramatically increased to 48.35, which represented change rates of -27.38% and 90.06%, respectively. The patient characteristics associated with an increased likelihood of undergoing LC were age, female gender, and lack of current comorbidities. The total treatment cost for the OC patients increased during the study period, whereas that for the LC patients declined. The LC patients were more responsive than the OC patients with respect to average length of hospital stay (ALOS) (-0.23; 95% CI, -0.33 to -0.13) and total treatment cost (-0.43; 95% CI, -0.63 to -0.23). Considerably increased total treatment cost was associated with advanced age, female gender, one or more co-morbidities, current treatment at a medical center, and long ALOS. Decreases in ALOS and total treatment cost were greater for the LC patients than for the OC patients. Government officials and health care providers should understand that total treatment cost depends on both patient and hospital attributes. These results can be generalized to patient populations elsewhere in Taiwan as well as to other countries with similar patient profiles.

Variations in the preoperative resources use and the practice pattern in Japanese cholecystectomy patients

There are several preoperative treatment options, such as the staged bile duct intervention (BDI), for the successful completion of a cholecystectomy, regardless of the use of an open cholecystectomy (OC) or a laparoscopic cholecystectomy (LC). However, few studies have investigated how the characteristics of the patient or the hospital affect the preoperative resource use. This study determined the factors, including the hospital characteristics, associated with the preoperative resource utilization or with the treatment process. Cholecystectomy patients (n = 12 627) who were treated for benign gallbladder diseases were examined. The study variables were: the patient demographics; the comorbid conditions; the presence of inflammation; the BDI, including endoscopic retrograde cholangiopancreatography, percutaneous gallbladder or common bile duct drainage, endoscopic sphincterotomy, clearance of choledocholithiasis; the preoperative length of stay (LOS) or the total charges; and the hospital region, ownership, and function. A multivariate analysis was used to measure the variables associated with the use of preoperative resources. A total of 11,690 (85.1%) patients underwent LC. The inflammation was diagnosed in 72.5% of OC and 41.5% of LC patients. Bile duct intervention was performed in more of the OC patients. The preoperative BDI had a significantly greater impact on the LOS. The hospital demographics predicted the preoperative resource use and the implementation of the BDI. The preoperative BDI involved the use of more preoperative resources. A wide variation of the use of BDI was observed in the hospital demographics. Further study is needed to establish a preoperative treatment strategy for cholecystectomy patients.

Contribution of bile duct drainage on resource use and clinical outcome of open or laparoscopic cholecystectomy in Japan

Laparoscopic cholecystectomy (LC) is replacing conventional open cholecystectomy (OC) as a preferred surgical method for treating complicated biliary tract disorders. However, there have been few studies assessing the impact of staged bile duct drainage (BDD) on costs and clinical outcomes for either surgical approach. This study evaluated the impact of surgical technique and BDD on resource utilization and complication rates. This study included 2778 cholecystectomy patients treated for benign biliary tract diseases in 80 academic and 81 community hospitals. For both OC and LC patients, the following variables were analysed: demographics, clinical data, length of stay (LOS), total charges (TC; US$), procedure-related complications and hospital type. Multivariate analyses were used to determine the impact of BDD on LOS, TC and complication rates. Of the 2778 cholecystectomy patients in the study, 2255 (81.2%) underwent LC. Inflammation was diagnosed in 55.6% of OC patients and 36.0% of LC patients. Complication was 9.4% in OC cases and 4.7% in LC cases. BDD was performed in 14.5% of OC cases and in 7.6% of LC cases. Diagnosis of inflammation, presence of co-morbidities and BDD each had a significant impact on LOS and TC. After risk adjustment, LC was associated with a reduction in LOS and TC, while BDD resulted in greater LOS and TC. LC and BDD were significantly associated with complications. The study suggested that BDD utilized more resources and had higher rates of complications. LC remains an appropriate procedure for cholecystectomy patients. Further study will be needed to evaluate the effect of pre-operative or post-operative BDD on quality of care.

QS352. Hospital Differences in Short-Term Outcomes for Uncomplicated Pediatric Patients With Gallbladder Disease

Background: The incidence of gallbladder disease and the use of laparoscopic cholecystectomy (LC) in pediatric patients have increased over the past 15 years. We hypothesized that dedicated children’s hospitals (CH), inclusive of both free-standing children’s hospitals and children’s hospitals within hospitals, would have better outcomes for various surgical procedures compared to similar pediatric patients treated at non-children’s hospitals (NCH). The purpose of our study was to examine the differences in the short-term outcomes and utilization of LC between CH and NCH for uncomplicated pediatric patients who underwent cholecystectomy for gallbladder disease. Methods: A retrospective study was performed of children 4 to 12 years of age who had a cholecystectomy for gallbladder disease in 2003 by extracting data from the Healthcare Cost and Utilization Project (HCUP) Kid’s Inpatient Database, which consists of 3 million discharge records from 36 states. Hospitals were categorized as CH by NACHRI criteria. Patients with significant comorbidities such as hepatic, intestinal and cardiac anomalies, cancer, trauma, cerebral palsy, chromosomal abnormalities, as well as prior or concurrent intra-abdominal operations for other diagnoses were excluded from the study. Results: There were 853 cholecystectomies performed in children between the ages 4-12 years old from the KID 2003 database. After excluding patients with significant comorbidities, 556 patients were included in the analysis. CH patients (56%) were slightly younger (9.9 vs. 10.6 years, p<0.005), less obese (3.4 vs. 10.7%, p<0.001), more likely to have sickle cell disease (26.7 vs. 6.2%, p<0.0001), and were more often admitted electively (58 vs. 41%, p<0.001) and during the weekday (90.1 vs. 83.7%, p<0.05) compared to NCH patients. Overall, CH patients had longer hospitalizations (3.34 vs. 2.52 days p<0.001), higher hospital charges ($20,125 vs. $17,919 p<0.05), and developed more complications during the operative hospitalization (3.4 vs. 0.9% p=0.05) despite having less emergency admissions. The utilization of LC was lower at CH compared to NCH (91 vs. 97% p<0.005), and LC patients at CH also had longer hospitalizations (3.31 vs. 2.49 days, p<0.001) and higher hospital charges ($20,027 vs. $17,746, p<0.05). The rates of choledocholithiasis, pancreatitis, ERCP, and LC conversion were not different between CH and NCH. Age, length of stay and total charges for open cholecystectomy patients alone were similar between CH and NCH. If sickle cell patients were excluded, CH patients still had lower LC utilization (89% vs. 97%, p<0.005) with longer hospitalization (3.12 vs. 2.44 days, p<0.01). Using multivariate regression analysis, the independent factors associated with longer hospitalization included treatment at CH, non-elective admission, sickle cell disease, and occurrence of complications (p<0.001). Conclusion: Children without significant comorbidities are more likely to have longer hospitalizations and higher charges when treated at CH for gallbladder disease compared to similar children treated at NCH. In addition to a lower use of LC at CH, similar differences in short-term outcomes are evident between CH and NCH when comparing only LC patients. Although complicated pediatric patients are best cared for at a tertiary care CH, there appears to be potential for improvement in short-term outcomes for uncomplicated patients with gallbladder disease treated at CH.

Laparoscopic Omental Harvest for Flap Coverage in Complex Mediastinitis

Mediastinitis is one of the most serious complications of cardiac surgery. The standard of care in mediastinitis includes thorough sequential debridement, flap coverage, and culture-directed antibiotics. The most frequently utilized muscles for flap reconstruction include the rectus abdominus and the pectoralis major. However, in some instances these flaps may be inadequate, unavailable, or fail, thus requiring an alternative choice or adjuvant. Most coronary graft procedures utilize the left internal mammary artery, frequently eliminating the left rectus muscles, while prior open cholecystectomy patients frequently lose availability of their right rectus muscle. In addition, radiation therapy or prior flap failure may exclude other muscle transfer procedures. The omentum offers excellent coverage due to mobility and superb arterial and lymphatic flow. Unfortunately, in the past, this has required a celiotomy in an already critically ill patient. We present a series of 5 patients where the omentum was mobilized laparoscopically and passed through an anterior diaphragmatic incision. This option spares a celiotomy, seals the wound, and hastens recovery in very ill patients. We also present a complete review of literature on the topic and provide an algorithm for complex sternal wound reconstruction.