Impact of Systemic Lupus Erythematosus (SLE) on Short-Term Outcomes of Cholecystectomy for Acute Cholecystitis: An Analysis of the US National Readmission Database, 2016-2020.

Abstract

Background/purpose: Systemic lupus erythematosus (SLE) may impact surgical outcomes of acute cholecystitis due to immune dysfunction and systemic inflammation. This study evaluated short-term outcomes of cholecystectomy in SLE patients using US Nationwide Readmissions Database data.

Methods: Adults (≥ 18 years) admitted with acute cholecystitis who underwent cholecystectomy between 2016 and 2020 were included. Patients with cholecystostomy or missing data were excluded. After 1:4 propensity score matching, multivariable logistic regression assessed associations between SLE and postoperative outcomes, with results reported as adjusted odds ratios (aORs).

Results: A total of 4400 patients were analyzed (880 with SLE; 3520 without). SLE was associated with higher odds of complications (aOR = 1.64, 95% CI: 1.30-2.08, p < 0.001), particularly sepsis (aOR = 2.41, 95% CI: 1.55-3.77, p < 0.001) and acute kidney injury (aOR = 1.64, 95% CI: 1.23-2.18, p = 0.001). SLE patients also had increased 30-day (aOR = 1.59, 95% CI: 1.24-2.03, p < 0.001) and 90-day (aOR = 1.61, 95% CI: 1.31-1.99, p < 0.001) readmission rates, longer hospital stays (β = 1.04 days), and higher costs (β = 13.01, 95% CI: 7.23-18.80, p < 0.001).

Conclusions: SLE is independently linked to worse short-term outcomes following cholecystectomy for acute cholecystitis. Tailored perioperative strategies are warranted for this high-risk group.