title: Open versus laparoscopic cholecystectomies in patients with or without type 2 diabetes mellitus in Spain from 2003 to 2013.
abstract: BACKGROUND
  This study aimed to compare the rates of open and laparoscopic cholecystectomies and outcomes in patients with or without type 2 diabetes mellitus (T2DM) in Spain from 2003 to 2013.
  
  
  METHODS
  We collected all cases of open and laparoscopic cholecystectomies using national hospital discharge data and evaluated the annual cholecystectomy rates stratified by T2DM status. We analyzed tendency for in-hospital mortality (IHM). We also analyzed the impact of T2DM on IHM in patients who underwent cholecystectomies.
  
  
  RESULTS
  We identified 611 533 cholecystectomies (71.3% laparoscopic) in the patients, in whom 78 227 (12.8%) patients had T2DM. The rates of open cholecystectomies were 3-fold higher (130.0/105 vs 41.1/105) in patients with T2DM than in those without T2DM, and the rate of laparoscopic cholecystectomies was almost 2-fold higher (195.2/105 vs 111.8/105) in patients with T2DM. The annual rate of laparoscopic procedures showed an 11-year relative increase of 88.3% (from 117.0/105 to 220.3/105) in T2DM and 49.2% (from 79.2/105 to 118.2/105) in patients without T2DM (P<0.001), whereas the rate of open procedures showed an 11-year relative decrease of 27.6% in patients with T2DM and 37.9% in those without T2DM (P<0.001). The rate of emergency laparoscopic cholecystectomy was increased in the 11 years, whereas the rate of emergency open cholecystectomies was decreased (both P<0.001). Multivariate analysis revealed that older age, higher comorbidity and emergency cholecystectomy were associated with a higher IHM. Compared with patients without T2DM, patients with T2DM demonstrated a lower IHM after open cholecystectomy [OR=0.82 (0.78-0.87)], but a higher IHM after laparoscopic cholecystectomy [OR=1.18 (1.03-1.35)]. Time-trend analyses showed a significant reduction in IHM in patients with or without T2DM after the two procedures.
  
  
  CONCLUSIONS
  The rate of cholecystectomy was higher in patients with T2DM, and laparoscopic cholecystectomy was popularized in the past 11 years both in selective and emergency cholecystectomies.
authors.affiliation: Internal Medicine Department, Hospital General Universitario "Gregorio Maranon", 46, Doctor Esquerdo, 28007, Madrid, Spain. josemaria.demiguel@salud.madrid.org.
authors.forename: Jose M
authors.initials: JM
authors.lastname: de Miguel-Yanes
authors.forename: Manuel
authors.initials: M
authors.lastname: Mendez-Bailon
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jimenez-Garcia
authors.forename: Valentin
authors.initials: V
authors.lastname: Hernandez-Barrera
authors.forename: Napoleon
authors.initials: N
authors.lastname: Perez-Farinos
authors.forename: Fernando
authors.initials: F
authors.lastname: Turegano
authors.forename: Nuria
authors.initials: N
authors.lastname: Munoz-Rivas
authors.forename: Ana
authors.initials: A
authors.lastname: Lopez-de-Andres
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome