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Introduction: Gallstone ileus is a challenging and uncommon disease process. No guidelines have been established regarding the timing of cholecystectomy in the management of gallstone ileus. We review a national database to evaluate the impact patients undergoing cholecystectomy in their initial hospital stay.
Methods: The Nationwide Inpatient Sample was searched for gallstone ileus patients (ICD-9 = 560.31) from 1998-2010. Only patients who underwent intestinal enterotomy (ICD-9 45.00-45.03) were included in this study. Variables studied were age, sex, length of stay, hospital teaching status, hospital charges, mortality, diagnoses and procedures. Data for patients who underwent cholecystectomy during their hospital stay (ICD-9 51.21-51.24) were compared to patients who did not.
Results: Over 13 years, 4,253 patients were hospitalized with gallstone ileus and had an intestinal enterotomy with a mean of 327 cases per year. Mean age was 74.9 years; 1,234 were male (29%) and 3,019 were female (71%). 861 patients (20.2%) underwent cholecystectomy during the same hospital visit. 89.8% underwent open cholecystectomy, 6.3% open partial cholecystectomy, 3.5% laparoscopic cholecystectomy and 0.5% laparoscopic partial cholecystectomy. Mean mortality rate was 6.1%. Diagnoses and mortality rates associated with increased risk of death were aspiration pneumonia (37.3%), septicemia (31.3%), respiratory failure (28.1%), pneumonia (27.5%), acidosis (19.9%), heart failure (16.9%), COPD (14.4%), mental disorders (12.6%), atrial fibrillation (12.0%) and post-operative infection (11.1%).
Conclusion: Gallstone ileus is more common in older women and was mostly treated by enterotomy alone. However, 20% of patients underwent cholecystectomy during their initial hospital visit. Most patients who underwent cholecystectomy underwent an open procedure. The length of stay, hospital charges and mortality rate were all greater in patients who underwent a cholecystectomy during their initial hospital stay. The mortality rate is also increased in patients who have underlying co-morbid conditions or who develop infectious complications such as septicemia, pneumonia and wound infections.
Comparison of Cholecystectomy and No Cholecystectomy

	Cholecystectomy	No Cholecystectomy
Length of Stay (Days)	14.8	11.6
Hospital Charges	$75,009	$53,208
Mortality	10.4%	5.0%