title: Gallstone ileus: revisiting surgical outcomes using National Surgical Quality Improvement Program data.
abstract: BACKGROUND
  Although surgical management remains the mainstay of therapy for gallstone ileus, the optimal approach--enterolithotomy alone or combined with biliary-enteric fistula disruption--is controversial because of the reliance on small single-center series to describe outcomes. Using the American College of Surgeons' National Surgical Quality Improvement Program database, we sought to (1) review the outcomes of patients undergoing surgical management of gallstone ileus and (2) determine if cholecystectomy in addition to enterolithotomy increased morbidity or mortality rate.
  
  
  METHODS
  We analyzed the demographics, comorbidities, acuity, operative time, postoperative hospitalization length, and 30-d morbidity and mortality rates of 127 patients from 2005 to 2010 who underwent a procedure for the relief of gallstone ileus. We identified a subset of 14 patients who underwent simultaneous cholecystectomy. We compared the "no cholecystectomy" and "cholecystectomy" groups using standard statistical methods.
  
  
  RESULTS
  The overall 30-d postoperative morbidity and mortality rate was 35.4% and 5.5%, respectively. Superficial surgical site infection and urinary tract infection were the most common complications. There was no significant difference in mortality rate between the no cholecystectomy and the cholecystectomy groups (5.3% versus 7.1%, respectively; P = 0.78), but the latter group did experience more minor complications, longer operations, and longer postoperative hospitalization.
  
  
  CONCLUSIONS
  Other recent studies on this topic have collected data or reviewed literature across several decades, making this study in particular one of the largest truly modern series. Perhaps reflecting changes in perioperative management, surgical treatment of gallstone ileus is less morbid than previously described, but there is still insufficient evidence to favor concurrent cholecystectomy.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. mohan.mallipeddi@duke.edu
authors.forename: Mohan K
authors.initials: MK
authors.lastname: Mallipeddi
authors.forename: Theodore N
authors.initials: TN
authors.lastname: Pappas
authors.forename: Mark L
authors.initials: ML
authors.lastname: Shapiro
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001658:Biliary Fistula / Q000401:mortality / Q000601:surgery; D002763:Cholecystectomy / Q000401:mortality; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D042882:Gallstones / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D045823:Ileus / Q000401:mortality* / Q000601:surgery*; D010535:Laparoscopy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement; D013530:Surgical Wound Infection / Q000401:mortality; D014552:Urinary Tract Infections / Q000401:mortality
keywords: Gallstone ileus; NSQIP