title: Complications of pediatric cholecystectomy: impact from hospital experience and use of cholangiography.
abstract: BACKGROUND
  Complications after cholecystectomy in children are poorly characterized. The aim of this study was to assess risk factors for major surgical complications for children undergoing cholecystectomy.
  
  
  METHODS
  All children 4 to 18 years old with gallbladder disease who underwent cholecystectomy from 1999 to 2006 were identified from the California Patient Discharge Database. Patient, hospital, and surgical factors were analyzed using multivariate logistic regression analysis to identify factors predictive of bile duct injury (BDI) and postoperative ERCP.
  
  
  RESULTS
  A cohort of 6,931 children treated at 360 hospitals was evaluated. Most children underwent cholecystectomy at a non-children's hospital (84%). Intraoperative cholangiogram (IOC) was performed in 2,053 (30%) children. Of 5,101 children tracked through the year after cholecystectomy, 153 (3%) required readmission for surgical complications. Bile duct injury occurred in 25 (0.36%) children, and postoperative ERCP was performed in 711 (10%) children. Older age (odds ratio = 0.80; 99% CI, 0.67-0.95) was associated with decreased risk of BDI. Increased hospital tendency for routine IOC use was associated with increased likelihood of BDI (odds ratio = 12.92; 99% CI, 1.31-127.15). Receiving surgical care at a children's hospital was associated with a decreased likelihood of postoperative ERCP (odds ratio = 0.39; 99% CI, 0.23-0.66). As anticipated, choledocholithiasis, cholecystitis, IOC, and laparoscopic cholecystectomy were associated with increased risk of postoperative ERCP (p < 0.01).
  
  
  CONCLUSIONS
  Serious complications and readmissions from pediatric cholecystectomy are uncommon. Surgeons performing cholecystectomy in young children must have an elevated concern about BDI. Routine IOC or surgical volume might not be helpful in lowering BDI rates.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA; Robert Wood Johnson Foundation Clinical Scholars, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Lorraine I
authors.initials: LI
authors.lastname: Kelley-Quon
authors.affiliation: Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Adrian
authors.initials: A
authors.lastname: Dokey
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Howard C
authors.initials: HC
authors.lastname: Jen
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: sshew@mednet.ucla.edu.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Shew
mesh_terms: D000293:Adolescent; D001652:Bile Ducts / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography / Q000706:statistics & numerical data; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000706:statistics & numerical data; D042883:Choledocholithiasis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors
keywords: BDI; CaPDD; California Patient Discharge Database; IOC; LOS; OR; bile duct injury; intraoperative cholangiogram; length of stay; odds ratio