Newly diagnosed and decompensated congestive heart failure is associated with increased rates of pneumonia, reintubation, and death following laparoscopic cholecystectomy: A NSQIP database review of 143,761 patients.
BACKGROUND
Laparoscopic cholecystectomy (LC) is routinely performed as an outpatient operation. NSQIP tracks acute or symptomatic congestive heart failure (CHF) within 30 days of the index operation. This study aims to quantify adverse events after LC and determine if patients with CHF may benefit from pre-operative optimization or post-operative admission.


MATERIALS AND METHODS
This is a retrospective NSQIP database review of all adults undergoing LC between 2008 and 2012. Comorbidities examined were acute or decompensated CHF, along with coronary artery disease, chronic obstructive pulmonary disease, diabetes, dyspnea, obesity, and smoking status. Bivariate and multivariate analyses determined the impact of these conditions on complications.


RESULTS
LCs were performed electively in 131,081 patients and emergently in 12,680 patients. Pneumonia, reintubation or death in CHF patients occurred in 9% and 18% of these operations, respectively. The odds ratios, among those with CHF compared to those without, for pulmonary complications was 4.7 (p < 0.01, 95%CI: 3.38-6.6) in the elective and 3.7 (p < 0.01, 95%CI: 1.89-7.07) in the emergent populations.


CONCLUSIONS
Patients with acute or decompensated CHF may benefit from pre-operative cardiac optimization and post-operative admission to decrease the risk of pulmonary complications.
['Hall|Chad M|CM|', 'Jupiter|Daniel C|DC|', 'Regner|Justin L|JL|']
D000328:Adult D000368:Aged D017081:Cholecystectomy, Laparoscopic D015897:Comorbidity D016208:Databases, Factual D005705:Gallbladder Diseases D006333:Heart Failure D006760:Hospitalization D006801:Humans D007442:Intubation, Intratracheal D008875:Middle Aged D011014:Pneumonia D011182:Postoperative Care D011300:Preoperative Care D012189:Retrospective Studies D014481:United States
Congestive heart failure Laparoscopic cholecystectomy NSQIP Gallbladder Gallstone Laparoscopic surgery