title: Anticipation of complications after laparoscopic cholecystectomy: prediction of individual outcome.
abstract: Complication rates after a laparoscopic cholecystectomy are still up to 10 %. Knowledge of individual patient risk profiles could help to reduce morbidity.
  
  
  
  The aim of this study is to create risk profiles for specific complications to anticipate on individual outcome.
  
  
  
  Individual patient outcome for a specific post-operative complication was assessed from a retrospective database of two major teaching hospitals, using uni- and multivariable analyses.
  
  
  
  A total of 4359 patients were included of which 346 developed one or more complications (8 %). Five risk profiles were found to predict specific complications: older patients (>65 year) are at risk for pneumonia (OR 7.0, 95 % CI 3.3-15.0, p < 0.001) and bleeding (OR 2.2, 95 % CI 1.2-3.9, p = 0.014), patients with acute cholecystitis are at risk for intra-abdominal abscess (OR 5.9, 95 % CI 3.4-10.1, p < 0.001), bile leakage (OR 3.6, 95 % CI 2.0-6.6, p < 0.001) and pneumonia (OR 3.5, 95 % CI 1.6-7.6, p < 0.002), previous history of cholecystitis is predictive for wound infection (OR 5.1, 95 % CI, (2.7-9.7), p < 0.001), intra-abdominal abscess (OR 6.1, 95 % CI 2.8-13.8, p < 0.001), post-operative bleeding (OR 4.8, 95 % CI 2.1-11.1, p < 0.001), bile leakage (OR 7.2, 95 % CI 3.4-15.4, p < 0.001) and pneumonia (OR 3.9, 95 % CI 1.3-11.9, p = 0.018), pre-operative ERCP is predictive for intra-abdominal abscess (OR 3.3, 95 % CI 2.0-5.7, p < 0.001), post-operative bleeding (OR 2.1, 95 % CI 1.2-3.9, p = 0.058) and pneumonia (OR 3.8, 95 % CI 1.9-7.8, p = 0.001), and converted patients are at risk for wound infection (OR 4.0, 95 % CI 2.1-7.7, p < 0.001) and intra-abdominal abscess (OR 3.5, 95 % CI 1.6-7.7, p = 0.002).
  
  
  
  Individual risk prediction of outcome after laparoscopic cholecystectomy is feasible. This facilitates individual pre-operative doctor-patient communication and may tailor surgical strategies.
authors.affiliation: Department of Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), PO-box 95500, 1090 HM, Amsterdam, The Netherlands. s.c.donkervoort@olvg.nl.
authors.forename: S C
authors.initials: SC
authors.lastname: Donkervoort
authors.affiliation: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Kortram
authors.affiliation: Department of Research and Epidemiology, OLVG, Amsterdam, The Netherlands.
authors.forename: L M
authors.initials: LM
authors.lastname: Dijksman
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Boermeester
authors.affiliation: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: van Ramshorst
authors.affiliation: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Boerma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D041761:Cholecystolithiasis / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Anticipation; Cholecystectomy; Individual; Laparoscopic; Post-operative complications