Published online Jun 27, 2017. doi: 10.4240/wjgs.v9.i6.149
Peer-review started: October 28, 2016
First decision: December 1, 2016
Revised: March 23, 2017
Accepted: April 23, 2017
Article in press: April 25, 2017
Published online: June 27, 2017
To evaluate the value of blood testing after elective laparoscopic cholecystectomy and its association with procedure related complications.
Charts of all patients undergoing elective laparoscopic cholecystectomy from January 2013 through December 2014 were reviewed retrospectively for demographics, indication for surgery, operative course and outcome. In our institution the decision to perform postoperative blood analysis is left for the discretion of the surgeon, therefore we had the possibility to compare the results of those who had blood analyses results to those who did not. Analysis was performed to identify variables associated with the decision to perform postoperative blood tests. Subsequently a univariate and multivariate analyses was performed comparing the two cohorts. Secondary subgroup analysis was performed to identify factors associated with procedure related complications.
Five hundred and thirty-two elective laparoscopic cholecystectomies for symptomatic gallstones were performed during the study period. Sixty-four percent of the patients (n = 340) had blood tests taken post operatively. Patients that had laboratory tests taken were older (P = 0.006, OR = 1.01), had longer surgery (P < 0.001, OR = 3.22) had more drains placed (P < 0.001, OR = 3.2) and stayed longer in the hospital (P < 0.001, OR = 1.2). A subgroup analysis of the patients who experienced complications revealed longer stay in the hospital (P < 0.001), higher body mass index (BMI) (P = 0.04, OR = 1.08), increased rates of drain placement (P = 0.006, OR = 3.1) and higher conversion rates (P = 0.01, OR = 14.6). Postoperative blood tests withdrawals were not associated with complications (P = 0.44). On Multivariate analysis BMI and drain placement were independently associated with complications.
The current study indicate that routine postoperative blood tests after elective laparoscopic cholecystectomy for symptomatic gallstones does not predict complications and may have an added benefit in diagnosis and management of cases were the surgeon encountered true technical difficulty during surgery.
Core tip: Laparoscopic cholecystectomy is the procedure of choice for patients with symptomatic gallstones. Although some patients will need overnight observation many of the younger patients, with low body mass index (BMI), that did not have severe gallbladder infection may be performed under day surgery, in institutions that have the necessary setup. The current study show that postoperative blood analyses does not predict nor correlate with postoperative complications and has no impact on outcome. The only independent predictors of complications on multivariate analysis are BMI and drain placement that was used a surrogate for technical difficulty during surgery. Intuitively length of surgery is thought to be in correlation with technical difficulty. In centers were supervised residents perform high percentage of the operations, length of surgery does not correlate with difficulty or post operative complications and by itself does not seem to indicate need for postoperative blood analyses.