Risk Factors and Complications Associated with Difficult Emergency Cholecystectomies: Experience of a Single Urban Center

Aim and objective: The aim and objective of this study is to determine the prevalence, risk factors, and complications of difficult cholecystectomy in our population. Materials and methods: A retrospective study was conducted from January 2016 through March 2017. Difficult cholecystectomy was the primary endpoint as defined by the surgeon in the operative report. Preoperative risk factors evaluated included: age, sex, obesity, pregnancy, resolved pancreatitis, choledocholithiasis resolved by endoscopic retrograde cholangiopancreatography (ERCP), and surgical wait time. Intraoperative factors evaluated including the presence of anatomical variants, operative time > 90 minutes, and the presence of liver disease. We measured the rate of conversion from laparoscopic to open, the incidence of postoperative complications, and overall mortality in this population. Results: Of 585 patients, 77.9% were admitted for acute cholecystitis, and 22.1% for symptomatic cholelithiasis, acute pancreatitis, or choledocholithiasis treated by ERCP. The prevalence of difficult cholecystectomy in our population was 37.6%. Preoperative risk factors correlating with difficult cholecystectomy included: male sex, and age > 65 years. Intraoperative risk factors included: the presence of an anatomic variant and surgical time > 90 minutes. Conclusion: The prevalence of difficult emergency cholecystectomy at our institution is high. There was a low rate of complications and conversion among patients with difficult cholecystectomies.