Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
J Hepatobiliary Pancreat Sci. 2022 Mar;29(3):338-348. doi: 10.1002/jhbp.852. Epub 2020 Nov 10.
The best surgical approach to treat acute cholecystitis (AC) in cirrhotic patients is controversial. This study aimed to evaluate treatment options in cirrhotic patients with AC. We hypothesized that laparoscopic cholecystectomy (LC) would lead to better clinical outcomes when compared to non-operative management (NOM) and open cholecystectomy (OC), independent of the severity of liver cirrhosis.
Patients from the National Inpatient Sample diagnosed with AC were stratified into no cirrhosis (NC), compensated cirrhosis (CC), and decompensated cirrhosis (DC) and analyzed according to treatment: NOM, OC, and LC. Primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (HLOS), cost, and surgical complications. Univariate and multivariate analyses using generalized linear models were performed. A P < 0.05 was deemed significant.
Of 1 367 495 AC patients, 49 030 (3.6%) had cirrhosis; 23 260 had CC, and 25 770 had DC. LC (12 080 in CC group and 4840 in DC group) was accompanied by significantly lower mortality, HLOS, complications, and cost when compared to OC and NOM. OC was significantly associated with higher mortality, increased HLOS, total cost, and postoperative complications, independent of the presence or severity of cirrhosis.
LC in cirrhotic patients leads to superior outcomes compared to OC and NOM regardless of the severity of cirrhosis.
治疗肝硬化合并急性胆囊炎（AC）的最佳手术方式仍存在争议。本研究旨在评估不同治疗方案对肝硬化合并 AC 患者的影响。我们假设，与非手术治疗（NOM）和开腹胆囊切除术（OC）相比，腹腔镜胆囊切除术（LC）能改善肝硬化患者的临床结局，且与肝硬化严重程度无关。
从国家住院患者样本中筛选出诊断为 AC 的患者，分为无肝硬化（NC）、代偿期肝硬化（CC）和失代偿期肝硬化（DC），并根据治疗方式分为 NOM、OC 和 LC。主要结局为院内死亡率。次要结局包括住院时间（HLOS）、费用和手术并发症。采用广义线性模型进行单因素和多因素分析。P<0.05 为差异有统计学意义。
在 1367495 例 AC 患者中，有 49030 例（3.6%）合并肝硬化，其中 23260 例为 CC，25770 例为 DC。LC（CC 组 12080 例，DC 组 4840 例）与 OC 和 NOM 相比，死亡率、HLOS、并发症和费用明显更低。OC 与更高的死亡率、更长的 HLOS、更高的总费用和术后并发症相关，且与肝硬化的存在或严重程度无关。
LC 可改善肝硬化患者的结局，优于 OC 和 NOM，且与肝硬化严重程度无关。
