Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Surg Endosc. 2014 Jul;28(7):2208-12. doi: 10.1007/s00464-014-3454-5. Epub 2014 Feb 25.
Laparoscopic cholecystectomy (LC) remains one of the most frequently performed surgical procedures. The safety of LC in patients with renal disease is unclear. The postoperative outcomes of elective LC in patients on dialysis were studied and risk factors associated with longer length of stay and mortality were sought.
Patients who underwent LC between the dates of 1 January 2007 and 31 December 2010 at all hospitals in North America participating in the American College of Surgeons National Surgical Quality Improvement Project were reviewed. Data from 80,995 patients were collected, and the patients on dialysis (N = 512) were separated and compared with those of patients not on dialysis (N = 80,483).
Postoperative complications for patients on and not on dialysis, respectively, included mortality (4.1 vs. 0.2%, p < 0.001), myocardial infarction (0.8 vs. 0.1%, p = 0.002), pneumonia (2.3 vs. 0.4%, p < 0.001), sepsis (3.1 vs. 0.4%, p < 0.001), and return to operating room (4.3 vs. 1.0%, p < 0.001). In patients on dialysis, multivariate analysis was used to identify risk factors, including congestive heart failure and prior cardiac surgery as significant independent predictors of longer length of stay and mortality.
Patients on dialysis who undergo LC should be carefully selected due to the significantly higher complication and mortality rate. Several predictors of longer length of stay and mortality were identified that can determine which patients on dialysis are good candidates for LC.
腹腔镜胆囊切除术（LC）仍然是最常进行的手术之一。患有肾脏疾病的患者行 LC 的安全性尚不清楚。本研究旨在探讨透析患者行择期 LC 的术后结局，并寻找与住院时间延长和死亡率相关的危险因素。
回顾了北美所有参与美国外科医师学会国家手术质量改进计划的医院在 2007 年 1 月 1 日至 2010 年 12 月 31 日期间行 LC 的患者。共收集了 80995 例患者的数据，将透析患者（N=512）与未透析患者（N=80483）进行了分离和比较。
分别有透析和未透析患者发生以下术后并发症：死亡率（4.1% vs. 0.2%，p<0.001）、心肌梗死（0.8% vs. 0.1%，p=0.002）、肺炎（2.3% vs. 0.4%，p<0.001）、脓毒症（3.1% vs. 0.4%，p<0.001）和重返手术室（4.3% vs. 1.0%，p<0.001）。在透析患者中，使用多变量分析确定了风险因素，包括充血性心力衰竭和既往心脏手术，这是住院时间延长和死亡率的显著独立预测因素。
由于透析患者的并发症和死亡率明显较高，因此对行 LC 的透析患者应进行仔细选择。确定了几个与住院时间延长和死亡率相关的预测因素，这些因素可以确定哪些透析患者是 LC 的合适人选。
