摘要
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 within 30 days from EIC.PSM resulted in 1166 patients(583 per group).Operative time was shorter when EIC was performed by HPB surgeons(115.5 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.Conclusions: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.
