Traumatic gallbladder injury and its treatment: Changing management of a rare injury.

Abstract

Introduction: Traumatic gallbladder injury has historically been associated with high morbidity and mortality. Whether treatment patterns have changed over time as non-operative management has been adopted for abdominal trauma care remains unclear. We sought to evaluate trends in cholecystectomy as a treatment for traumatic gallbladder injury and estimate the association between operative or non-operative management of traumatic gallbladder injury and patient outcomes.

Methods: Retrospective cohort analysis of the National Trauma Data Bank from 2007-2021 evaluating patients with traumatic gallbladder injury and determining whether they received no intervention, endoscopic retrograde cholangiopancreatography (ERCP), or cholecystectomy. The probability of a patient receiving cholecystectomy or operative intervention was evaluated with an adjusted multivariable logistic regression model. To estimate the effect of intervention choice on in-hospital mortality, length of stay, and intensive care unit (ICU) length of stay, an adjusted multivariable logistic regression model was used, treating the year as a fixed effect.

Results: There were 6160 traumatic gallbladder injuries recorded from 2007-2021. 3909 (63.5 %) of these patients underwent some form of intervention (drainage or cholecystectomy), including 3722 (60.4 %) undergoing cholecystectomy. The odds of cholecystectomy compared to non-operative management were decreased in several, but not all, years of study as time progressed. There was no statistically significant difference in the odds of ERCP over time. Cholecystectomy was associated with decreased odds of in-hospital mortality (aOR 0.26, 95 % CI 0.22, 0.30; p < 0.001) and 16.5 % longer length of stay (coefficient 0.15, 95 % CI 0.10-0.20; p < 0.001) compared to non-operative management.

Conclusions: Cholecystectomy use for traumatic gallbladder injury has decreased from 2007-2021 without a concurrent increase in ERCP. Patients who underwent cholecystectomy had lower odds of mortality in adjusted models. The increasing use of non-operative management for traumatic gallbladder injury may carry greater risk to patients, and operative intervention should remain the standard of care.