title: Surgery for gallstone ileus: a nationwide comparison of trends and outcomes.
abstract: BACKGROUND
  Gallstone ileus is a mechanical bowel obstruction caused by a biliary calculus originating from a bilioenteric fistula. Because of the limited number of reported cases, the optimal surgical method of treatment has been the subject of ongoing debate.
  
  
  METHODS
  A retrospective review of the Nationwide Inpatient Sample from 2004 to 2009 was performed for gallstone ileus cases treated surgically by enterotomy with stone extraction alone (ES), enterotomy and cholecystectomy with fistula closure (EF), bowel resection alone (BR), and bowel resection with fistula closure (BF). Patient demographics, hospital factors, comorbidities, and postoperative outcomes were reported. Multivariate analysis was performed comparing mortality, morbidity, length of stay, and total cost for the different procedure types.
  
  
  RESULTS
  Of the estimated 3,452,536 cases of mechanical bowel obstruction from 2004 to 2009, 3268 (0.095%) were due to gallstone ileus-an incidence lower than previously reported. The majority of patients were elderly women (>70%). ES was the most commonly performed procedure (62% of patients) followed by EF (19% of cases). In 19%, a bowel resection was required. The most common complication was acute renal failure (30.44% of cases). In-hospital mortality was 6.67%. On multivariate analysis, EF and BR were independently associated with higher mortality than ES [(odds ratio [OR] = 2.86; confidence interval [CI]: 1.16-7.07) and (OR = 2.96; CI: 1.26-6.96) respectively]. BR was also associated with a higher complication rate, OR = 1.98 (CI: 1.13-3.46).
  
  
  CONCLUSIONS
  Gallstone ileus is a rare surgical disease affecting mainly the elderly female population. Mortality rates appear to be lower than previously reported in the literature. Enterotomy with stone extraction alone appears to be associated with better outcomes than more invasive techniques.
authors.affiliation: *Department of Surgery, University of California-Irvine School of Medicine; and †Department of Statistics, University of California-Irvine, Irvine, CA.
authors.forename: Wissam J
authors.initials: WJ
authors.lastname: Halabi
authors.forename: Celeste Y
authors.initials: CY
authors.lastname: Kang
authors.forename: Noor
authors.initials: N
authors.lastname: Ketana
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Lafaro
authors.forename: Vinh Q
authors.initials: VQ
authors.lastname: Nguyen
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
authors.forename: David K
authors.initials: DK
authors.lastname: Imagawa
authors.forename: Aram N
authors.initials: AN
authors.lastname: Demirjian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001658:Biliary Fistula / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D002763:Cholecystectomy / Q000706:statistics & numerical data / Q000639:trends; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007412:Intestinal Fistula / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology