Objectives

Acute cholecystitis is a complication in critically ill patients. However, a few studies have described its incidence, risk factors, and mortality in patients who underwent cardiovascular surgery. We investigated the incidence, perioperative predictors, and clinical features of acute cholecystitis after cardiovascular surgery.

Methods

This retrospective cohort study examined 7013 patients who underwent cardiovascular surgery between October 2000 and March 2019 at a tertiary care hospital. We collected preoperative, intraoperative, and postoperative data from our database and electronic medical records. The primary outcome was the incidence of postoperative cholecystitis until hospital discharge. A multivariable logistic regression analysis to estimate perioperative predictors of acute cholecystitis was conducted. We described the clinical characteristics of patients complicated with acute cholecystitis.

Results

Among the 7013 patients, 51 (0.7%) developed acute cholecystitis. Logistic regression analysis found that circulatory arrest (odds ratio [OR] 1.97; 95% confidence interval [CI] 1.04–3.74; P = 0.037) and intraoperative massive transfusion (OR 2.03; 95% CI 1.03–4.01; P = 0.041) were associated with the incidences of cholecystitis. In-hospital mortality was significantly higher in the cholecystitis group than in the non-cholecystitis group (13.7% vs 3.9%, P = 0.004). Aortic disease was more frequent in the cholecystitis group (54.9% vs 38.6%, P = 0.021). The median time of acute cholecystitis onset from surgery was 12.5 days (interquartile range 7.0–27.75). Twenty-six patients (51.0%) developed asymptomatic cholecystitis.

Conclusions

Approximately 1% of patients who underwent cardiovascular surgery developed postoperative cholecystitis; half of them were asymptomatic. Since cholecystitis is associated with high mortality, it is a complication after cardiovascular surgery that needs to be considered.

中文翻译：

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心血管手术后急性胆囊炎的发生率及危险因素

目标

急性胆囊炎是重症患者的并发症。然而，一些研究描述了其在接受心血管手术的患者中的发病率、危险因素和死亡率。我们调查了心血管手术后急性胆囊炎的发生率、围手术期预测因素和临床特征。

方法

这项回顾性队列研究检查了 2000 年 10 月至 2019 年 3 月期间在一家三级医院接受心血管手术的 7013 名患者。我们从我们的数据库和电子病历中收集了术前、术中和术后数据。主要结果是出院前术后胆囊炎的发生率。进行了多变量逻辑回归分析，以估计急性胆囊炎的围手术期预测因素。我们描述了急性胆囊炎患者的临床特征。

结果

在 7013 名患者中，51 名（0.7%）发生了急性胆囊炎。Logistic 回归分析发现，停循环（比值比 [OR] 1.97；95% 置信区间 [CI] 1.04-3.74；P  = 0.037）和术中大量输血（OR 2.03；95% CI 1.03-4.01；P  = 0.041）与胆囊炎的发生有关。胆囊炎组的住院死亡率显着高于非胆囊炎组（13.7% vs 3.9%，P  = 0.004）。胆囊炎组的主动脉疾病更常见（54.9% vs 38.6%，P  = 0.021）。手术后急性胆囊炎发作的中位时间为 12.5 天（四分位距 7.0-27.75）。26 名患者 (51.0%) 出现无症状胆囊炎。

结论

大约 1% 接受心血管手术的患者出现术后胆囊炎；其中一半没有症状。由于胆囊炎与高死亡率相关，因此需要考虑心血管手术后的并发症。