Department of Surgery, Howard University Hospital, Washington, DC.
Department of Surgery, Howard University Hospital, Washington, DC.
J Am Coll Surg. 2020 Jun;230(6):1020-1024. doi: 10.1016/j.jamcollsurg.2020.02.046. Epub 2020 Mar 30.
Cholecystectomy is the most commonly performed procedure in sickle cell disease (SCD) patients, but outcomes after cholecystectomy have not been well studied. Our aim was to explore the characteristics and outcomes of cholecystectomy in patients with SCD compared with patients without SCD, and assess whether acuity of presentation played a role.
Patients younger than age 35, with the primary diagnosis of gallbladder disease, who underwent cholecystectomy, were identified in the Nationwide Inpatient Sample (2005 to 2014). Patients were grouped into treatment groups by sickle cell status and acuity of surgery. Patient demographics, length of stay, hospital charges, and complications were evaluated. Descriptive and multivariate regression analyses were performed to compare these groups.
There were 149,415 patients analyzed; 1,225 (0.82%) had SCD. SCD was associated with higher complication rates (2.69% vs 1.12%), longer lengths of stay (3 days vs 2 days), and higher median hospital charge ($29,170 vs $25,438) (all p < 0.01). Stratified by level of acuity, comparing the SCD group with the non-SCD group, higher complication rates were seen in the acute presentation group (3.92% vs 1.00%, p < 0.01), but were not demonstrated in the elective group (0.98% vs 1.95%, p = 0.114).
SCD patients appear to have a longer length of stay, higher hospital spending, and increased complication rates compared with non-SCD patients undergoing cholecystectomy. This difference is pronounced among patients who underwent surgery in the acute setting. The data suggest that planned cholecystectomy may be beneficial in improving postoperative outcomes in SCD patients.
胆囊切除术是镰状细胞病（SCD）患者最常进行的手术，但胆囊切除术的结果尚未得到很好的研究。我们的目的是探讨 SCD 患者与非 SCD 患者胆囊切除术的特点和结果，并评估发病急缓是否起作用。
在全国住院患者样本（2005 年至 2014 年）中，确定年龄小于 35 岁、原发性胆囊疾病且行胆囊切除术的患者。根据镰状细胞状态和手术急缓程度将患者分为治疗组。评估患者人口统计学特征、住院时间、住院费用和并发症。进行描述性和多变量回归分析比较这些组。
共分析了 149415 例患者；其中 1225 例（0.82%）患有 SCD。SCD 与更高的并发症发生率（2.69% vs 1.12%）、更长的住院时间（3 天 vs 2 天）和更高的中位住院费用（$29170 与 $25438）相关（均 p < 0.01）。按发病急缓程度分层，与非 SCD 组相比，SCD 组在急性发作组的并发症发生率更高（3.92% vs 1.00%，p < 0.01），但在择期组中未见差异（0.98% vs 1.95%，p = 0.114）。
与非 SCD 患者行胆囊切除术相比，SCD 患者的住院时间更长、住院花费更高、并发症发生率更高。在急性发作的患者中，这种差异更为显著。数据表明，计划性胆囊切除术可能有利于改善 SCD 患者的术后结果。
