AMBROSE STUDY
30-DAy MorBidity and MoRtality Of CholecyStEctomy for Benign Gall Bladder Disease:
A TUGS Multinational Audit
STUDY OBJECTIVES
1) Evaluate 30-day morbidity and mortality of cholecystectomy for benign gall bladder diseases
2) Identify factors associated with 30-day morbidity and mortality of cholecystectomy for benign gall bladder diseases
INCLUSION CRITERIA
1) Study period: 1st January 2022 to 30th June 2022
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2) Patient population: Adults (>/=18 years)
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3) Intervention: elective and emergency laparoscopic, laparoscopic converted to open, or open cholecystectomy
4) Indication: benign gallbladder diseases diagnosed by clinical evaluation and gallbladder imaging – biliary colic, acute cholecystitis, choledocholithiasis, cholangitis and biliary pancreatitis, benign gall bladder polyp, acalculous cholecystitis, functional gall bladder disorders
5) Surgery performed anywhere in the world
EXCLUSION CRITERIA
1) Surgery outside the study period.
2) Patients <18 years of age.
3) Patients diagnosed intraoperatively or postoperatively with gallbladder cancer
4) Cholecystectomy as a part of another surgical procedure, e.g., pancreaticoduodenectomy or concurrent bariatric surgery
Abstract
Objective:
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This study aimed to assess 30-day morbidity and mortality rates following cholecystectomy for benign gallbladder disease and identify the factors associated with complications.
Background:
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Although cholecystectomy is common for benign gallbladder disease, there is a gap in the knowledge of the current practice and variations on a global level.
Methods:
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A prospective, international, observational collaborative cohort study of consecutive patients undergoing cholecystectomy for benign gallbladder disease from participating hospitals in 57 countries between January 1 and June 30, 2022, was performed. Univariate and multivariate logistic regression models were used to identify preoperative and operative variables associated with 30-day postoperative outcomes.
Results:
Data of 21,706 surgical patients from 57 countries were included in the analysis. A total of 10,821 (49.9%), 4263 (19.7%), and 6622 (30.5%) cholecystectomies were performed in the elective, emergency, and delayed settings, respectively. Thirty-day postoperative complications were observed in 1738 patients (8.0%), including mortality in 83 patients (0.4%). Bile leaks (Strasberg grade A) were reported in 278 (1.3%) patients, and severe bile duct injuries (Strasberg grades B–E) were reported in 48 (0.2%) patients. Patient age, American Society of Anesthesiologists physical status class, surgical setting, operative approach, and Nassar operative difficulty grade were identified as the 5 predictors demonstrating the highest relative importance in predicting postoperative complications.
Conclusions:
This multinational observational collaborative cohort study presents a comprehensive report of the current practices and outcomes of cholecystectomy for benign gallbladder disease. Ongoing global collaborative evaluations and initiatives are needed to promote quality assurance and improvement in cholecystectomy.