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LAPAROSCOPIC CHOLECYSTECTOMY IS SAFE IN THE SETTING OF HEREDITARY COAGULATION DISORDERS: A PROPENSITY MATCHED ANALYSIS OF THE NATIONWIDE READMISSIONS DATABASE
Sean H. Nguyen
*, John Martone, Colin Tang-Whitmore, Pravin D. Meshram, Cheyenna M. Espinoza, Mark T. Reding, Todd Costantini, James V. Harmon
University of Minnesota Medical School, Minneapolis, MN
Background:Hemophilia and von Willebrand Disease (VWD) are hereditary coagulation disorders (HCD) characterized by abnormal bleeding. Patients with HCD are at increased risk of bleeding both during and for two weeks after surgical procedures; however, reported outcomes of routine general surgery operations, such as laparoscopic cholecystectomy, have been limited to case reports and small series. This retrospective study evaluates and compares national patient outcomes following laparoscopic cholecystectomy in patients with hereditary coagulation disorders.
Methods:
The National Readmission Database was interrogated to retrospectively analyze admissions and readmissions from 2016 to 2021. ICD-10 codes identified adults who underwent primary laparoscopic cholecystectomy due to biliary pathology, with and without HCD. Hereditary coagulation disorders were defined as a composite of any hereditary hemophilia or hereditary VWD. Propensity score matching (2:1) using a nearest neighbor matching algorithm created two similar cohorts. Primary outcomes included in-hospital mortality and 30-day hospital readmission. Secondary outcomes included length of hospital stay, discharge disposition, and complications.
Results / Outcomes:A total of 323 consecutive patients with HCD who underwent laparoscopic cholecystectomy were matched with 642 laparoscopic cholecystectomy patients without HCD (51.8% women, mean age 52.6±17.4 years). After matching, there were no significant differences in age, sex, year, primary payer, patient location, income, hospital type, or Elixhauser Comorbidity Index. There were no differences in primary outcomes of in-hospital mortality (HCD: 0.2% vs. non-HCD: 0%, P=0.48) and 30-day readmission (8.0% vs. 7.6%, P=0.82). Composite complications also did not differ between cohorts (11.1% vs. 7.6%, P=0.069). Length of stay was similar (median 3 [2-5] days for both, P=0.069). Rate of disposition to home did not differ. Subanalysis of individual complications during index admission revealed no significant difference in organ system complications, bleeding or bile duct injury. Thirty day readmission in the HCD cohort was primarily due to bleeding (20%) and was more often due to bleeding compared to the non-HCD cohort (20% vs. 4%, P=0.025).
Conclusion:This retrospective and propensity matched national database analysis suggests that laparoscopic cholecystectomy is safe in patients with hemophilia and von Willebrand Disease. No significant differences in mortality, 30-day readmissions, or inpatient complications compared to patients without HCD were identified. However, HCD readmission was more often associated with bleeding. These findings, derived from the largest cohort study to date, provide reassuring evidence for the surgical management of gallbladder disease in patients with HCD.
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