title: Laparoscopic cholecystectomy is the preferred approach in cirrhosis: a nationwide, population-based study.
abstract: OBJECTIVE
  To assess the impact of open versus laparoscopic surgery in cirrhotic patients undergoing a cholecystectomy using the Nationwide Inpatient Sample (NIS).
  
  
  METHODS
  All patients with cirrhosis who underwent a cholecystectomy (open or laparoscopic) between 2003 and 2006 were queried from the NIS. Associated complications including infection, transfusion, reoperation, liver failure and mortality were determined.
  
  
  RESULTS
  A total of 3240 patients with cirrhosis underwent a cholecystectomy: 383 patients underwent an open cholecystectomy (OC) whereas 2857 patients underwent a laparoscopic cholecystectomy (LC), which included 412 patients converted (LCC) from a LC to an OC. Post-operative infection was higher in OC as opposed to a laparoscopic cholecystectomy (TLC) or LCC (3.5% versus 0.7% versus 0.2%, P < 0.0001). The need for a blood transfusion was significantly higher in the OC and LCC groups as compared with the TLC group (19.2% versus 14.4% versus 6.2%, P < 0.0001). Reoperation was more frequent after OC or LCC versus TLC (1.5% versus 2.5% versus 0.8%, P = 0.007). In-hospital mortality was higher after OC as compared with TLC and LCC (8.3% versus 1.3% versus 1.4%, P < 0.0001).
  
  
  CONCLUSIONS
  Patients with cirrhosis have increased in-hospital morbidity and mortality after an open as opposed to a laparoscopic or conversion to an open cholecystectomy. LC should be the preferred initial approach in cirrhotic patients.
authors.affiliation: Department of Surgery and Office of Clinical Research, Jersey Shore University Medical Center, Robert Wood Johnson Medical School, Neptune, NJ, USA.
authors.forename: David K
authors.initials: DK
authors.lastname: Chmielecki
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Hagopian
authors.forename: Yen-Hong
authors.initials: YH
authors.lastname: Kuo
authors.forename: Yen-Liang
authors.initials: YL
authors.lastname: Kuo
authors.forename: John M
authors.initials: JM
authors.lastname: Davis
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005705:Gallbladder Diseases / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome