Impact of Heart Failure on Outcomes After Laparoscopic Cholecystectomy for Acute Cholecystitis: A Propensity Score-Matched Analysis of the United States Nationwide Inpatient Sample.

INTRODUCTION: Few studies have examined outcomes of laparoscopic cholecystectomy for acute cholecystitis in patients with heart failure (HF). This study was to assess the impact of HF on cholecystectomy outcomes.

METHODS: Data from the United States Nationwide Inpatient Sample (NIS) from 2016 to 2020 were examined. Adults 20 years and older diagnosed with acute cholecystitis who underwent laparoscopic cholecystectomy were included. Patients were categorized into groups with and without pre-existing HF.

RESULTS: Outcomes assessed included inhospital mortality, nonroutine discharge, length of hospital stay, total hospital cost, and complications. Propensity score matching at a 1:1 ratio was conducted to balance between-group characteristics. Associations between HF and the outcomes were determined using univariate and multivariable regression analyses. After propensity score matching, 11,646 patients were included in the analysis: 5,823 with HF and 5,823 without. Patients with HF had significantly elevated risks of inhospital mortality (adjusted odds ratio [aOR] = 2.14, 95% confidence interval [CI]: 1.44-3.17), nonroutine discharge (aOR = 1.80, 95% CI: 1.61-2.01), and complications (aOR = 1.51, 95% CI: 1.40-1.63). Patients with HF also had longer length of hospital stay (1.52 days, 95% CI: 1.45-1.60) and higher total hospital costs (16.64 thousand USD, 95% CI: 15.58-17.70). The outcomes of patients with HF were seen in those with HF reduced ejection fraction and HF with preserved ejection fraction.

DISCUSSION: Patients with HF, either HF reduced ejection fraction or HF with preserved ejection fraction, have increased risk of adverse inpatient outcomes after laparoscopic cholecystectomy for acute cholecystitis. This emphasizes the importance of tailored perioperative care to optimize patient outcomes.