Background

Emergency index-admission cholecystectomy (EIC) is recommended for acute cholecystitis in most cases. General surgeons have less exposure in managing “difficult” cholecystectomies. This study aimed to compare the outcomes of EIC between hepatopancreatobiliary (HPB) versus non-HPB surgeons.

Methods

This is a 10-year retrospective audit on patients who underwent EIC from December 2011 to March 2022. Patients who underwent open cholecystectomy, had previous cholecystitis, previous endoscopic retrograde cholangiopancreatography or cholecystostomy were excluded. A 1:1 propensity score matching (PSM) was performed to adjust for confounding variables (e.g. age ≥ 75 years, history of abdominal surgery, presence of dense adhesions).

Results

There were 1409 patients (684 HPB cases, 725 non-HPB cases) in the unmatched cohort. Majority (52.3%) of them were males with a mean age of 59.2 ± 14.9 years. Among 472 (33.5%) patients with EIC performed ≥ 72 hours after presentation, 40.1% had dense adhesion. The incidence of any morbidity, open conversion, subtotal cholecystectomy and bile duct injury were 12.4%, 5.0%, 14.6% and 0.1%, respectively. There was one mortality at day 30 after surgery. PSM resulted in 1166 patients (583 per group). Operative time was shorter when EIC was performed by HPB surgeons (115.5 min vs. 133.4 min, P < 0.001). The mean length of hospital stay was comparable. EIC performed by HPB surgeons was independently associated with lower open conversion [odds ratio (OR) = 0.24, 95% confidence interval (CI): 0.12-0.49, P < 0.001], lower fundus-first cholecystectomy (OR = 0.58, 95% CI: 0.35-0.95, P = 0.032), but higher subtotal cholecystectomy (OR = 4.19, 95% CI: 2.24-7.84, P < 0.001). Any morbidity, bile duct injury and mortality were comparable between the two groups.

Conclusion

EIC performed by HPB surgeons were associated with shorter operative time and reduced risk of open conversion. However, the incidence of subtotal cholecystectomy was higher.

中文翻译：

---

与非肝胰胆外科医生相比，由肝胰胆外科医生进行的紧急入院腹腔镜胆囊切除术的结果是否更好？使用 1:1 倾向评分匹配进行 10 年审计

背景

在大多数情况下，建议对急性胆囊炎进行紧急入院胆囊切除术（EIC）。普通外科医生在处理“困难”胆囊切除术方面的接触较少。本研究旨在比较肝胆胰 (HPB) 外科医生与非 HPB 外科医生的 EIC 结果。

方法

这是对2011年12月至2022年3月接受EIC的患者进行的10年回顾性审计。接受开腹胆囊切除术、既往有胆囊炎、既往内镜逆行胰胆管造影或胆囊造口术的患者被排除在外。进行1:1倾向评分匹配（PSM）以调整混杂变量（例如年龄≥75岁、腹部手术史、存在致密粘连）。

结果

未匹配队列中有 1409 名患者（684 名 HPB 病例，725 名非 HP​​B 病例）。其中大多数（52.3%）为男性，平均年龄为 59.2 ± 14.9 岁。在 472 名 (33.5%) 的 EIC 患者中，在就诊后 72 小时以上进行检查，其中 40.1% 存在致密粘连。任何并发症、开放性中转、胆囊次全切除术和胆管损伤的发生率分别为 12.4%、5.0%、14.6% 和 0.1%。术后第 30 天出现 1 例死亡。PSM 结果为 1166 名患者（每组 583 名）。当 HPB 外科医生进行 EIC 时，手术时间更短（115.5 分钟 vs. 133.4 分钟，P < 0.001）。平均住院时间相当。HPB 外科医生进行的 EIC 与较低的开放转换率 [比值比 (OR) = 0.24，95% 置信区间 (CI)：0.12-0.49，P < 0.001]、较低的眼底胆囊切除术（OR = 0.58，95%）独立相关CI：0.35-0.95，P  = 0.032），但胆囊次全切除术较高（OR = 4.19，95% CI：2.24-7.84，P < 0.001）。两组之间的发病率、胆管损伤和死亡率相当。

结论

HPB 外科医生进行的 EIC 可以缩短手术时间并降低开放性中转风险。然而，胆囊次全切除术的发生率较高。