Complications, length of stay, and cost of cholecystectomy in kidney transplant recipients

Abstract

We hypothesized that cholecystectomy may be riskier for kidney transplant recipients (KTR) given their lifelong immunosuppression, physiologic impact of renal failure, and increased risk of gallstone and biliary disease. Using NIS, we compared mortality, morbidity, length of stay and cost in KTR vs non-KTR following cholecystectomy in the US from 2000 to 2011, adjusting for patient and hospital level factors, including transplant center status. Mortality was higher (OR 2.4), morbidity was higher (OR 1.3), LOS was longer (ratio 1.2), and costs were greater (ratio 1.1) for KTR compared to non-KTR following cholecystectomy. While it is clear that KTR are a high risk group following cholecystectomy, the cause of this increased risk requires further investigation.

Incidence and Mortality of Emergency General Surgery Conditions Among Solid Organ Transplant Recipients in Ontario, Canada: A Population-based Analysis

“…DiBrito et al compared mortality following appendectomy, cholecystectomy, and colorectal resections in kidney transplant recipients with that of nontransplant patients and found that mortality was similar for appendectomy but higher for cholecystectomy (2.7% versus 1.2%, adjusted OR 2.39, 95% CI 1.66-3.44) and colorectal resections (11.1% versus 4.3%, adjusted OR 2.68, 95% CI 3.59-4.81) in transplant recipients. [23][24][25] However, these studies included elective operations and lacked data on the indication for surgery and therefore were not limited to EGS conditions. Moreover, patients undergoing nonoperative management for EGS conditions were excluded from the previous studies.…”

“…58 Last, immunosuppression and underlying comorbidities make transplant recipients also more susceptible to infectious, cardiovascular, and respiratory complications. 23,24 Additional research is required to elucidate the modifiable risk factors associated with an increased risk of death after EGS events in SOTRs. Where the patient received care (transplant versus, nontransplant hospital) and involvement of transplant physicians also warrant further investigation.…”

“…However, these studies were limited to kidney transplant recipients, included mostly elective operations, lacked data on the indication for surgery, and excluded patients undergoing nonoperative management. 23–26…”

“…However, these studies were limited to kidney transplant recipients, included mostly elective operations, lacked data on the indication for surgery, and excluded patients undergoing nonoperative management. [23][24][25][26] Improving our understanding of the impact of EGS conditions in this population is essential to the provision of high-quality care. The diagnosis of EGS conditions in SOTRs is challenging and delays in treatment may lead to worse outcomes.…”

Clinical and financial outcomes of transplant recipients following emergency general surgery operations

“…Although prior studies have sought to characterize the volume and outcomes of transplant recipients requiring EGS operations, they are largely limited to single centers or evaluate single conditions [ 5 , [7] , [8] , [9] ]. Additionally, data regarding the cost burden of hospitalizations and readmissions, is lacking.…”