Safety of elective laparoscopic cholecystectomy in patients on dialysis: An analysis of the ACS NSQIP database

Background: Laparoscopic cholecystectomy (LC) remains one of the most frequently performed surgical procedures. The safety of LC in patients with renal disease is unclear. The postoperative outcomes of elective LC in patients on dialysis were studied and risk factors associated with longer length of stay and mortality were sought. Methods: Patients who underwent LC between the dates of 1 January 2007 and 31 December 2010 at all hospitals in North America participating in the American College of Surgeons National Surgical Quality Improvement Project were reviewed. Data from 80,995 patients were collected, and the patients on dialysis (N = 512) were separated and compared with those of patients not on dialysis (N = 80,483). Results: Postoperative complications for patients on and not on dialysis, respectively, included mortality (4.1 vs. 0.2 %, p < 0.001), myocardial infarction (0.8 vs. 0.1 %, p = 0.002), pneumonia (2.3 vs. 0.4 %, p < 0.001), sepsis (3.1 vs. 0.4 %, p < 0.001), and return to operating room (4.3 vs. 1.0 %, p < 0.001). In patients on dialysis, multivariate analysis was used to identify risk factors, including congestive heart failure and prior cardiac surgery as significant independent predictors of longer length of stay and mortality. Conclusion: Patients on dialysis who undergo LC should be carefully selected due to the significantly higher complication and mortality rate. Several predictors of longer length of stay and mortality were identified that can determine which patients on dialysis are good candidates for LC.