Predictors of Major Complications after Laparoscopic Cholecystectomy: Surgeon, Hospital, or Patient?

Murphy, Melissa M.; Ng, Sing Chau; Simons, Jessica P.; Csikesz, Nicholas G.; Shah, Shimul A.; Tseng, Jennifer F.

doi:10.1016/j.jamcollsurg.2010.02.050

Cited by 106 publications

(77 citation statements)

References 26 publications

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“…While it appears that gross mortality rates exceed today's standards, the authors believe that the subgroup of patients with high ASA scores require separate consideration: Most fatalities in our study were attributable to nonsurgical complications such as perioperative myocardial infarction or congestive heart failure typically seen in ASA score III and IV patients. Similar to our and the aforementioned Scottish trial [24], Murphy et al [23] could demonstrate that advanced age, comorbidities and male gender are key factors associated with in-hospital complications in their analysis of 1,102,071 LC patients. In fact, Melloul et al in their comparison of percutaneous drainage vs. emergency LC in acute cholecystitis in critically ill patients found mortality rates of 13% (drainage) and 16% (LC), highlighting the potential risks in this vulnerable group of patients [25].…”

Section: Discussionsupporting

confidence: 90%

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Laparoscopic cholecystectomy as a teaching operation: comparison of outcome between residents and attending surgeons in 1,747 patients

Fahrner

Turina

Neuhaus

et al. 2011

Langenbecks Arch Surg

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Purpose Standardized surgical training is increasingly confronted with the public demand for high quality of surgical care in modern teaching hospitals. The aim of this study was to compare the results of laparoscopic cholecystectomy (LC) performed by resident surgeons (RS) and attending surgeons (AS). Methods In this retrospective review of prospectively collected data 1,747 LC were performed in a community hospital between 1999 and 2009. Seven hundred seventy operations were performed by RS. Parameters analysed included the duration of operation and length of hospital stay, intraoperative complications, 30-day morbidity and mortality. Results Duration of operation was 88 (25-245) min for RS vs. 75 (30-190) min by AS (p=0.001). Elective operations were shorter when performed by

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Section: Discussionsupporting

confidence: 90%

“…Despite observing a decrease in overall mortality from 1% to 0.3% during the study period, our overall mortality of 0.6% is slightly higher than that of several previous reports (ranging from 0.3% to 0.5%) [2,22,23]. Mortality was higher in urgent (1%) than elective LC (0.3%) and was to our surprise not associated with surgeons' experience.…”

Section: Discussioncontrasting

confidence: 81%

Laparoscopic cholecystectomy as a teaching operation: comparison of outcome between residents and attending surgeons in 1,747 patients

Fahrner

Turina

Neuhaus

et al. 2011

Langenbecks Arch Surg

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“…The following patient and nonpatient factors have inconsistently been suggested as enlarging the risk for conversion: gender, age, body mass index (BMI), previous abdominal surgery, previous endoscopic retrograde cholangiography (ERC), acute cholecystitis, and equipment failure [2,3,12,20,30]. Surgeon experience and case load have been reported, but surgeon specialization has not been a well-studied topic to date [3,6,11,21,28,29].…”

mentioning

confidence: 99%

Outcome of laparoscopic cholecystectomy conversion: is the surgeon’s selection needed?

et al. 2012

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“…Similar studies have been published for open and laparoscopic surgery. 5,7,[12][13][14] Two series 15,16 have reported the risk factors associated with robotic urology, however, neither was designed to assess the complications following robotic general surgery.…”

Section: Commentmentioning

confidence: 99%

“…A low volume hospital 5 or a low surgeon case volume 22 is related to a higher mortality rate. 14,15,38 At our center, we perform more than 270 robotic procedures per year, thus our caseload corresponds to a high-volume center. Our mortality rate (0.5%) is also similar to those reported previously for an open high-volume hospital.…”

Section: Quality Of Surgical Performancementioning

confidence: 99%

Perioperative Risk Assessment in Robotic General Surgery

Buchs¹,

Addeo²,

Bianco³

et al. 2012

Arch Surg

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Eight hundred eightyfour consecutive patients who underwent a robotic procedure in our institution between April 2007 and July 2010. Main Outcomes Measures: Perioperative morbidity and mortality.Results: During the study period, 884 patients underwent a robotic procedure. The conversion rate was 2%, the mortality rate was 0.5%, and the overall postoperative morbidity rate was 16.7%. The reoperation rate was 2.4%. Mean length of stay was 4.5 days (range, 0.2-113 days). In univariate analysis, several factors were associated with increased morbidity and included either patientrelated (cardiovascular and renal comorbidities, Ameri-can Society of Anesthesiologists score Ն3, body mass index [calculated as weight in kilograms divided by height in meters squared] Ͻ30, age Ն70 years, and malignant disease) or procedure-related (blood loss Ն500 mL, transfusion, multiquadrant operation, and advanced procedure) factors. In multivariate analysis, advanced procedure, multiquadrant surgery, malignant disease, body mass index of less than 30, hypertension, and transfusion were factors significantly associated with a higher risk for complications. American Society of Anesthesiologists score of 3 or greater, age 70 years or older, cardiovascular comorbidity, and blood loss of 500 mL or more were also associated with increased risk for mortality.Conclusions: Use of the robotic approach for general surgery can be achieved safely with low morbidity and mortality. Several risk factors have been identified as independent causes for higher morbidity and mortality. These can be used to identify patients at risk before and during the surgery and, in the future, to develop a scoring system for the use of robotic general surgery.

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Predictors of Major Complications after Laparoscopic Cholecystectomy: Surgeon, Hospital, or Patient?

Cited by 106 publications

References 26 publications

Laparoscopic cholecystectomy as a teaching operation: comparison of outcome between residents and attending surgeons in 1,747 patients

Laparoscopic cholecystectomy as a teaching operation: comparison of outcome between residents and attending surgeons in 1,747 patients

Outcome of laparoscopic cholecystectomy conversion: is the surgeon’s selection needed?

Perioperative Risk Assessment in Robotic General Surgery

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