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| Open versus laparoscopic cholecystectomies in patients with or without type 2 diabetes mellitus in Spain from 2003 to 2013 |
| Jose M de Miguel-Yanes, Manuel Mendez-Bailon, Rodrigo Jimenez-Garcia, Valentin Hernandez-Barrera, Napoleon Perez-Farinos, Fernando Turegano, Nuria Munoz-Rivas and Ana Lopez-de-Andres |
Madrid, Spain
Author Affiliations: Internal Medicine Department (de Miguel-Yanes JM) and Surgery Department (Turegano F), Hospital General Universitario “Gregorio Maranon”, 46, Doctor Esquerdo, 28007, Madrid, Spain; Internal Medicine Department, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, 28040, Madrid, Spain (Mendez-Bailon M); Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas, Alcorcón, 28292, Madrid, Spain (Jimenez-García R, Hernandez-Barrera V and Lopez-de-Andres A); Spanish Agency of Alimentary Safety and Nutrition, Ministry of Health, Social Policy and Equality, 56, Alcala, 28071, Madrid, Spain (Perez-Farinos N); and Internal Medicine Department, Hospital Infanta Leonor, 80, Avenida Gran Vía del Este, 28031, Madrid, Spain (Munoz-Rivas N)
Corresponding Author: Dr. Jose M de Miguel-Yanes, Servicio de Medicina Interna, Hospital Gregorio Maranon, 46, Doctor Esquerdo, 28007, Madrid, Spain (Tel: +34915868522; Email: josemaria.demiguel@salud.madrid.org) |
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Abstract BACKGROUND: This study aimed to compare the rates of open and laparoscopic cholecystectomies and outcomes in patients with or without type 2 diabetes mellitus (T2DM) in Spain from 2003 to 2013.
METHODS: We collected all cases of open and laparoscopic cholecystectomies using national hospital discharge data and evaluated the annual cholecystectomy rates stratified by T2DM status. We analyzed tendency for in-hospital mortality (IHM). We also analyzed the impact of T2DM on IHM in patients who underwent cholecystectomies.
RESULTS: We identified 611 533 cholecystectomies (71.3% laparoscopic) in the patients, in whom 78 227 (12.8%) patients had T2DM. The rates of open cholecystectomies were 3-fold higher (130.0/105 vs 41.1/105) in patients with T2DM than in those without T2DM, and the rate of laparoscopic cholecystectomies was almost 2-fold higher (195.2/105 vs 111.8/105) in patients with T2DM. The annual rate of laparoscopic procedures showed an 11-year relative increase of 88.3% (from 117.0/105 to 220.3/105) in T2DM and 49.2% (from 79.2/105 to 118.2/105) in patients without T2DM (P<0.001), whereas the rate of open procedures showed an 11-year relative decrease of 27.6% in patients with T2DM and 37.9% in those without T2DM (P<0.001). The rate of emergency laparoscopic cholecystectomy was increased in the 11 years, whereas the rate of emergency open cholecystectomies was decreased (both P<0.001). Multivariate analysis revealed that older age, higher comorbidity and emergency cholecystectomy were associated with a higher IHM. Compared with patients without T2DM, patients with T2DM demonstrated a lower IHM after open cholecystectomy [OR=0.82 (0.78-0.87)], but a higher IHM after laparoscopic cholecystectomy [OR=1.18 (1.03-1.35)]. Time-trend analyses showed a significant reduction in IHM in patients with or without T2DM after the two procedures.
CONCLUSION: The rate of cholecystectomy was higher in patients with T2DM, and laparoscopic cholecystectomy was popularized in the past 11 years both in selective and emergency cholecystectomies.
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2016, Vol. 15 
