Comparing outcomes of operative management of intestinal obstruction due to gallstone ileus using NSQIP database

Abstract

Introduction: Gallstone ileus is an uncommon etiology of intestinal obstruction, although many cases require surgical repair. There is no consensus regarding the necessity of concomitant cholecystectomy. (CCY) at the time of index surgery. This study aimed to evaluate the outcomes of gallstone ileus in patients with and without CCY.

Methods: Using the ACS NSQIP database from 2005 to 2019, we included patients who underwent surgical management of gallstone ileus (enterolithotomy) with or without CCY. The primary outcomes of interest were surgical site infection (SSI) and 30-day mortality. Additional outcomes of interest included readmissions related to the procedure, length of hospital stay (LOS), return to the operating room, and sepsis. Demographics were evaluated using univariate analysis, whereas outcomes of interest were analyzed using multivariate logistic regression.

Results: A total of 825 cases of gallstone ileus were identified among 118 patients who underwent cholecystectomy. Patient characteristics were similar between the groups. No concomitant cholecystectomy was associated with a longer hospital stay (8 days vs. five days, p<0.01) and tended to be more likely to return to the operating room (45 cases vs. 4 cases, p = 0.08), but this was not statistically significant. No concomitant CCY was associated with increased SSI rates, readmissions related to the procedure, 30-day mortality, or sepsis.

Conclusion: Surgical management of gallstone ileus with or without CCY has similar short-term postoperative outcomes.