Predictors of prolongation of the hospital stay in patients with cholecystolithiasis after laparoscopic surgical interventions on the gallbladder

Abstract

The purpose of the study is to identify predictors associated with prolongation of the period of hospital stay more than 48 hours in patients with cholecystolithiasis after laparoscopic surgery on the gallbladder (laparoscopic cholecystectomy and cholecystolithotomy).

Material and methods. The one-center open prospective study involved 136 patients with cholecystolithiasis. The average age of the patients was 48.9 ± 12.6 years (from 22 to 78 years), 79.41 % – women. Laparoscopic cholecystectomy was performed in 103 patients, of which 53 patients had 4-port laparoscopic cholecystectomy (4PLC) and 50 patients – single-incision laparoscopic cholecystectomy (SILC). Laparoscopic cholecystolithotomy (LCLT) was performed in 33 patients. Groups of patients were comparable by age. The baseline indices of laboratory general-clinical and biochemical blood tests, ultrasound scan of the hepato-biliary system, the duration of surgical intervention and the duration of stay in the hospital were evaluated. Predictors were determined using binary logistic regression.

Results. The average duration of laparoscopic cholecystolithotomy was 61.06 ± 13.27 minutes, which was significantly longer than the duration of laparoscopic four-port cholecystectomy (42.83 ± 16.97 minutes, P = 0.001) and single-port cholecystectomy (36.60 ± 14.37 minutes, P = 0.001). The average duration of SILC (36.60 ± 14.37 minutes) was significantly shorter than the mean duration of 4PLC (42.83 ± 16.97 minutes), (P = 0.039). The average stay in hospital after surgery (4PLC, SILC and LCLT) did not exceed 4.2 days, and the shortest period of postoperative hospital stay was in patients with the LCLT group, although the difference did not reach the limit of statistical probability. Most of the studied parameters, including anthropometric (body weight, height, body mass index, age, gender), had no probable effect on the duration of staying in hospital after surgery. The excess of fibrinogen in the blood serum from the baseline of over 2.2 g/L in patients with cholecystolithiasis increases the risk of delay in the hospital more than 48 hours after the intervention by 20 times (95 % CI 2.97–136.61; P = 0.002). The decrease of the hemoglobin level <135 g / L in the preoperative period was associated with an increase of odds ratio of prolonging the stay of patients in the hospital for more than 72 hours by 2.48 times (95 % CI 1.16–5.29), and the absence of an increase in body temperature on the first day after the operation on the gallbladder reduced the odds ratio of stay in the hospital by 66% (VS = 0.34; 95 % DI 0.1661–0.6885; P = 0.0028).

Conclusions. The influence of the type of laparoscopic intervention (SILC, 4PLC, LCLT) on the duration of postoperative stay of patients with cholecystolithiasis has not been established. The predictor of staying in the hospital for more than 48 hours after operation in patients with cholecystolithiasis was the preoperative level of fibrinogen above 2.2 g/l. The level of hemoglobin before the surgery on the gallbladder less than 135 g/l increases the risk of prolonged postoperative stay of patients for more than 72 hours by 2.48 times, and the absence of increased body temperature on the first day after the operation reduces the risk of delay in the hospital for more than three days by 66 %.