Abstract
This study examines the outcomes of open and laparoscopic cholecystectomy (OC/LC) in veterans with cirrhosis and develops a nomogram to predict outcomes.
We analyzed the Veterans Affairs Surgical Quality Improvement Program to identify all patients with cirrhosis and ascites who underwent cholecystectomy from 2008 to 2015. Univariate and multivariate regression were used to identify predictors of morbidity and mortality. A predictive nomogram was constructed and internally validated.
A total of 349 patients were identified. Overall, complications occurred in 18.7% of patients, and mortality was 3.8%. LC was performed in 58.9%, and 19.2% were preformed emergently. Overall, Model for End-Stage Liver Disease score was an independent factor of morbidity and mortality, while laparoscopic approach had a protective effect on morbidity.
Although cholecystectomy is a high-risk operation in cirrhotic veterans, LC may have favorable outcomes than OC in selected patients. An easy-to-use nomogram to predict morbidity and mortality for cirrhotic patients undergoing cholecystectomy is proposed.
•Cholecystectomy in cirrhotic veterans is associated with high morbidity and mortality.•Laparoscopic cholecystectomy may offer better outcomes compared with open approach in selected patients.•MELD score is an important predictor of outcomes.•Easy to use nomograms are priceless tool to aid in perioperative assessment.
Using VASQIP database, laparoscopic cholecystectomy may offer better outcomes compared with open approach in selected cirrhotic veterans. Reliable nomograms were created using this data to estimate both 90-day mortality and complication rates in this population.