title: Cholecystectomy concomitant with laparoscopic gastric bypass: a trend analysis of the nationwide inpatient sample from 2001 to 2008.
abstract: BACKGROUND
  Gallstone formation is common in obese patients, particularly during rapid weight loss. Whether a concomitant cholecystectomy should be performed during laparoscopic gastric bypass surgery is still contentious. We aimed to analyze trends in concomitant cholecystectomy and laparoscopic gastric bypass surgery (2001-2008), to identify factors associated with concomitant cholecystectomy, and to compare short-term outcomes after laparoscopic gastric bypass with and without concomitant cholecystectomy.
  
  
  METHODS
  We used data from adults undergoing laparoscopic gastric bypass for obesity from the Nationwide Inpatient Sample. The Cochran-Armitage trend test was used to assess changes over time. Unadjusted and risk-adjusted generalized linear models were performed to assess predictors of concomitant cholecystectomy and to assess postoperative short-term outcomes.
  
  
  RESULTS
  A total of 70,287 patients were included: mean age was 43.1 years and 81.6% were female. Concomitant cholecystectomy was performed in 6,402 (9.1%) patients. The proportion of patients undergoing concomitant cholecystectomy decreased significantly from 26.3% in 2001 to 3.7% in 2008 (p for trend < 0.001). Patients who underwent concomitant cholecystectomy had higher rates of mortality (unadjusted odds ratios [OR], 2.16; p = 0.012), overall postoperative complications (risk-adjusted OR, 1.59; p = 0.001), and reinterventions (risk-adjusted OR, 3.83; p < 0.001), less frequent routine discharge (risk-adjusted OR, 0.70; p = 0.05), and longer adjusted hospital stay (median difference, 0.4 days; p < 0.001).
  
  
  CONCLUSIONS
  Concomitant cholecystectomy and laparoscopic gastric bypass surgery have decreased significantly over the last decade. Given the higher rates of postoperative complications, reinterventions, mortality, as well as longer hospital stay, concomitant cholecystectomy should only be considered in patients with symptomatic gallbladder disease.
authors.affiliation: Research on Research Group, Department of Surgery, Duke University Medical Center, DUMC 3094, Durham, NC 27710, USA. mathias.worni@duke.edu
authors.forename: Mathias
authors.initials: M
authors.lastname: Worni
authors.forename: Ulrich
authors.initials: U
authors.lastname: Guller
authors.forename: Anand
authors.initials: A
authors.lastname: Shah
authors.forename: Mihir
authors.initials: M
authors.lastname: Gandhi
authors.forename: Jatin
authors.initials: J
authors.lastname: Shah
authors.forename: Dimple
authors.initials: D
authors.lastname: Rajgor
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: Danny O
authors.initials: DO
authors.lastname: Jacobs
authors.forename: Truls
authors.initials: T
authors.lastname: Ostbye
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends; D002769:Cholelithiasis / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000706:statistics & numerical data* / Q000639:trends; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012494:Sampling Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015431:Weight Loss