title: Gallbladder damage control: compromised procedure for compromised patients.
abstract: BACKGROUND
  The objective of this study was to analyze a population-based database for (1) recent 9-year trends in utilization of partial cholecystectomy (PC), laparoscopic PC, and trocar cholecystostomy (TC), (2) demographics, associated diagnoses, and hospital characteristics, and (3) relevant inpatient outcomes.
  
  
  METHODS
  Retrospective cohort analysis of the Nationwide Inpatient Sample (NIS) files from 2000 to 2008 was performed. For the purposes of the study, gallbladder damage control was defined as PC, laparoscopic PC, and TC.
  
  
  RESULTS
  A national estimate of 10,872 gallbladder damage control cases was obtained. Procedures performed included PC (47.8 %), laparoscopic PC (27.2 %), TC (25.3 %), and intraoperative cholangiogram (IOC) (19.7 %). A total of 1,479 (13.6 %) postoperative complications were identified, including pulmonary complications (4.3 %), hemorrhage/hematoma/seroma (3.4 %), and accidental puncture or laceration during procedure (3.3 %). Common bile duct injury occurred in 3.3 % overall. Hospital types included nonteaching (82.1 %) and urban (67.8 %), with regional variations of 42.1 % from the South and 45.2 % from the West. Inpatient outcomes included mean length of stay of 11.4 (0.16 SEM) days, mean total hospital charge of $71,296.69 ($1,106.03 SEM), 7.4 % mortality, and 16.8 % discharge to skilled nursing facility. Multivariate logistic regression analysis identified independent risk variables for common bile duct injury: teaching hospitals (OR = 1.517, CI = 1.155-1.991, P = 0.003). IOC (OR = 2.030, CI = 1.590-2.591, P < 0.001) was a commonly associated procedure in the setting of common bile duct injury.
  
  
  CONCLUSIONS
  Various circumstances may require gallbladder damage control with PC and TC. Postoperative complications and common bile duct injury remain significantly high despite limited resection, and the teaching status of the hospital is associated with CBD injury. High morbidity and mortality of gallbladder damage control may reflect both the compromised nature of the procedures and multiple comorbidities.
authors.affiliation: St. Elizabeth Medical Center, Tufts University School of Medicine, 736 Cambridge Street, Boston, MA 02135, USA. Justin.Lee@tufts.edu
authors.forename: Justin
authors.initials: J
authors.lastname: Lee
authors.forename: Peter
authors.initials: P
authors.lastname: Miller
authors.forename: Reza
authors.initials: R
authors.lastname: Kermani
authors.forename: Haisar
authors.initials: H
authors.lastname: Dao
authors.forename: Kevin
authors.initials: K
authors.lastname: O'Donnell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography; D002763:Cholecystectomy / Q000379:methods* / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000706:statistics & numerical data; D015331:Cohort Studies; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005704:Gallbladder / Q000293:injuries*; D006801:Humans; D007432:Intraoperative Period; D022125:Lacerations / Q000453:epidemiology / Q000517:prevention & control; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome