Inpatient Outcomes of Laparoscopic Cholecystectomy in Patients with Sickle Cell Disease

Introduction: Cholelithiasis is a common complication in patients with sickle cell disease (SCD), making cholecystectomy one of the most common surgical procedures in this population. Up to 85% of SCD patients develop gallstones by their third decade, and chronic hemolysis caused by the disease can lead to gallstones that block the bile duct. This study aimed to evaluate the outcomes of laparoscopic cholecystectomy in hospitalized patients with SCD using data extracted from a nationwide database.

Methods: The Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) was used to identify adult patients with SCD during 2016 - 2020 using ICD-10-CM codes (D57). ICD-10-PCS codes were used to identify patients who had laparoscopic cholecystectomy procedures. The main outcomes were in-hospital mortality, length of stay (LOS), and hospital costs, and secondary outcomes included acute pancreatitis, chronic pancreatitis, renal cancer, leukemia, lymphoma, Epstein-Barr virus (EBV), gastrointestinal (GI) bleeding, and pancreatic cancer. The association between laparoscopic cholecystectomy and outcomes was evaluated using survey-based multivariate logistic regression models for in-hospital mortality and secondary outcomes, Poisson regression for LOS, and a generalized linear model with gamma distribution and log link for hospitalization cost. Models were adjusted for age, sex, race and ethnicity, primary payer, Charlson comorbidity index, hospital bed size, hospital region, and hospital teaching status.

Results: A total of 899,610 SCD hospitalizations between 2016 and 2020 in the United States were identified, and 4,925 (0.55%) of them had laparoscopic cholecystectomy procedures. Out of 4925, 3620 (74%) patients were >18 years of age, and 3185 (65%) were female. Medicaid was the most common insurance source amongst those who had laparoscopic cholecystectomy (2410, 49%). Inpatient mortality and length of stay were not significantly different in SCD patients with laparoscopic cholecystectomy compared to those without laparoscopic cholecystectomy (inpatient mortality: 0.6% vs 0.6%, adjusted OR: 1.22, 95%CI: 0.55 - 2.72, p = 0.3; length of stay: 4.9 vs 5.1 days, p<0.001). SCD patients with laparoscopic cholecystectomy had an increased cost of hospitalization ($18,673 ± 475 vs $11,789 ± 106, p=0.004). SCD patients with laparoscopic cholecystectomy had increased odds of having acute pancreatitis (13% vs 0.5%, p < 0.001).

Conclusion: This analysis found that inpatient laparoscopic cholecystectomy is infrequent among SCD patients. However, they are associated with higher hospitalization costs and acute pancreatitis diagnoses. Further studies are needed to optimize surgical care in patients with SCD, mainly regarding cost implications, acute complications, and outcomes.

Winer:MDX: Consultancy.