title: Mortality after a cholecystectomy: a population-based study.
abstract: BACKGROUND
  The trade-off between the benefits of surgery for gallstone disease for a large population and the risk of lethal outcome in a small minority requires knowledge of the overall mortality.
  
  
  METHODS
  Between 2007 and 2010, 47 912 cholecystectomies for gallstone disease were registered in the Swedish Register for Cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) (GallRiks). By linkage to the Swedish Death Register, the 30-day mortality after surgery was determined. The age- and sex-standardized mortality ratio (SMR) was estimated by dividing the observed mortality with the expected mortality rate in the Swedish general population 2007. The Charlson Comorbidity Index (CCI) was estimated by International Classification of Diseases (ICD) codes retrieved from the National Patient Register.
  
  
  RESULTS
  Within 30 days after surgery, 72 (0.15%) patients died. The 30-day mortality was close [SMR = 2.58; 95% confidence interval (CI): 2.02-3.25] to that of the Swedish general population. In multivariable logistic regression analysis, predictors of 30-day mortality were age >70 years [odds ratio (OR) 7.04, CI: 2.23-22.26], CCI > 2 (OR 1.93, CI: 1.06-3.51), American Society of Anesthesiologists (ASA) > 2 (OR 13.28, CI: 4.64-38.02), acute surgery (OR 10.05, CI:2.41-41.95), open surgical approach (OR 2.20, CI: 1.55-4.69) and peri-operative complications (OR 3.27, CI: 1.74-6.15).
  
  
  CONCLUSIONS
  Mortality after cholecystectomy is low. Co-morbidity and peri-operative complications may, however, increase mortality substantially. The increased mortality risk associated with open cholecystectomy could be explained by confounding factors influencing the decision to perform open surgery.
authors.affiliation: Division of Surgery, Institution of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandblom
authors.forename: Per
authors.initials: P
authors.lastname: Videhult
authors.forename: Ylva
authors.initials: Y
authors.lastname: Crona Guterstam
authors.forename: Annika
authors.initials: A
authors.lastname: Svenner
authors.forename: Omid
authors.initials: O
authors.lastname: Sadr-Azodi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002763:Cholecystectomy / Q000379:methods / Q000401:mortality*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000401:mortality; D002769:Cholelithiasis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013548:Sweden; D016896:Treatment Outcome