Outcomes following cholecystectomy in pregnant and nonpregnant women.
BACKGROUND
This study is the first population-based measurement of outcomes after cholecystectomy during pregnancy.


METHODS
We identified all pregnant women who underwent cholecystectomy in the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, 1996-2006. Outcomes were fetal, maternal, and surgical complications, length of stay (LOS), and hospital cost. Pregnant and nonpregnant women were compared to examine the effects of pregnancy on laparoscopic cholecystectomy outcomes.


RESULTS
A total of 9,714 pregnant women underwent cholecystectomy (laparoscopic, 89%). Maternal and fetal complication rates were 4.3% and 5.8%, respectively. Pregnant women who underwent laparoscopic cholecystectomy compared to pregnant women who underwent open procedures had higher rates of surgical (19% vs 10%), maternal (9% vs 4%), and fetal (11% vs 5%) complications; longer LOS (6 vs 4 days); and higher cost ($13,198 vs $9,229), all P < .0001. High-volume surgeons were associated with lower rates of surgical (10% vs 13%; P < .05), maternal (1% vs 14%), and fetal (4% vs 10%) complications; shorter LOS (4 vs 5 days); and lower cost ($8,365 vs $10,350), all P < .0001. Patients with Medicaid coverage were associated with higher rates of surgical complications (13% vs 9%), longer LOS (4.3 vs 3.7 days), and higher cost ($10,403 vs $9,037), all P < .0001. On multivariable analysis, these factors remained independent predictors of outcome. Pregnancy was associated with longer LOS and higher cost.


CONCLUSIONS
Complications of cholecystectomy during pregnancy are significant, with disparities based on modifiable variables.
Kuy
Sreyram
S
Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT 06520, USA.
Roman
Sanziana A
SA
Desai
Rani
R
Sosa
Julie Ann
JA
D000328:Adult; D001660:Biliary Tract Diseases / Q000191:economics / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects / Q000191:economics; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000191:economics; D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000601:surgery*; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult