title: Newly diagnosed and decompensated congestive heart failure is associated with increased rates of pneumonia, reintubation, and death following laparoscopic cholecystectomy: A NSQIP database review of 143,761 patients.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) is routinely performed as an outpatient operation. NSQIP tracks acute or symptomatic congestive heart failure (CHF) within 30 days of the index operation. This study aims to quantify adverse events after LC and determine if patients with CHF may benefit from pre-operative optimization or post-operative admission.
  
  
  METHODS
  This is a retrospective NSQIP database review of all adults undergoing LC between 2008 and 2012. Comorbidities examined were acute or decompensated CHF, along with coronary artery disease, chronic obstructive pulmonary disease, diabetes, dyspnea, obesity, and smoking status. Bivariate and multivariate analyses determined the impact of these conditions on complications.
  
  
  RESULTS
  LCs were performed electively in 131,081 patients and emergently in 12,680 patients. Pneumonia, reintubation or death in CHF patients occurred in 9% and 18% of these operations, respectively. The odds ratios, among those with CHF compared to those without, for pulmonary complications was 4.7 (p < 0.01, 95%CI: 3.38-6.6) in the elective and 3.7 (p < 0.01, 95%CI: 1.89-7.07) in the emergent populations.
  
  
  CONCLUSIONS
  Patients with acute or decompensated CHF may benefit from pre-operative cardiac optimization and post-operative admission to decrease the risk of pulmonary complications.
authors.affiliation: Baylor Scott and White Health, 2401 S. 31st St., Temple, TX, 76502, USA. Electronic address: chad.hall@bswhealth.org.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Hall
authors.affiliation: University of Texas Medical Branch, 1.134G Ewing Hall, Galveston, TX, 77555-1150, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Jupiter
authors.affiliation: Baylor Scott and White Health, 2401 S. 31st St., Temple, TX, 76502, USA.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Regner
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000706:statistics & numerical data; D015897:Comorbidity; D016208:Databases, Factual; D005705:Gallbladder Diseases / Q000453:epidemiology / Q000601:surgery; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011182:Postoperative Care; D011300:Preoperative Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Congestive heart failure; Gallbladder; Gallstone; Laparoscopic cholecystectomy; Laparoscopic surgery; NSQIP