# Postoperative Outcomes Following Cholecystectomy: A Nationwide Analysis

## TL;DR

This study analyzed nationwide cholecystectomy outcomes in Malta, finding a 4.5% readmission rate within 30 days, lower than recommended guidelines.

## Contribution

The study provides a contemporary nationwide audit of cholecystectomy readmission rates in Malta, comparing them to established guidelines.

## Key findings

- The 30-day readmission rate following cholecystectomy was 4.5%, below the recommended 10%.
- Most patients were discharged within one day of surgery, with surgical complications being the main cause of readmission.
- Laparoscopic cholecystectomy was the most common procedure, with only a small percentage requiring open surgery.

## Abstract

Introduction

Laparoscopic cholecystectomy has revolutionized the surgical approach to gallbladder removal and has since then become the gold standard. Despite the significant benefits of laparoscopic cholecystectomy, complications requiring hospital readmission remain a cause for morbidity. The nationwide audit aims to assess the 30-day readmission rate following cholecystectomy in Malta and compare these findings to guidelines recommending a readmission rate of less than 10%.

Method

All patients, male and female, who underwent a cholecystectomy in the year of 2023 were identified from the hospital operating theater records. After compiling the patient list and obtaining ethical approval, hospital records, including electronic discharge summaries and radiological investigations, were reviewed to collect data on demographics, indication for cholecystectomy, and cause for readmission.

Results

In 2023, a total of 288 patients underwent cholecystectomy at Mater Dei Hospital. Of these, 168 (58.3%) patients were female and 120 (41.7%) were male, with the majority falling within the 50-59 age range. Most surgeries, n = 282 (97.9%), were elective, with only six patients requiring emergency intervention. Cholecystectomy was performed in the majority of cases as laparoscopy n = 279 (96.9%), one surgery was performed as an open procedure (<1%), and eight cases (2.8%) were converted from laparoscopic to open surgery.

The most common indication for cholecystectomy was cholecystitis (n=138, 47.9%), cholelithiasis (n=89, 30.9%), and pancreatitis (n=45, 15.6%). Two patients had cholecystectomy for malignancy (n = 2, 0.69%). The remaining patients had surgery secondary to porcelain gallbladder (n = 2), gallbladder polyps (n = 7), rupture (n = 1), adenomyosis and dysmotility (n = 4), collectively making up 4.86%. Preoperative imaging with magnetic resonance cholangiopancreatography (MRCP)/endoscopic retrograde cholangiopancreatography (ERCP) was conducted in 175 patients (60.7%), while 113 patients (39.2%) did not undergo any form of imaging prior to surgery.

Regarding postoperative outcomes, 84 patients (29.1%) were discharged on the same day as their procedure, with the majority, n = 128 (44.4%), discharged the following day. N = 50 (17.36%) patients stayed in hospital for 2-5 days, n = 21 patients stayed in hospital for 6-10 days (7.30%). Only n = 5 (1.74%) patients stayed in the hospital for > 10 days.

In total, 13 patients (4.5%) were readmitted, with the most common reasons being surgical complications, n = 9 (69.2%). Other causes of readmission included medical complications, which account for n = 4 (30.8%) of the readmitted cohort.

Conclusion

The 30-day readmission rate stood at 4.5%. This rate should be considered in light of the fact that the majority of patients were discharged just one day after surgery.