Pregnant patients undergoing cholecystectomy: nationwide assessment of clinical characteristics and outcomes

Abstract

Gallstone disease in pregnancy is one of the most common indications for non-obstetric surgery during pregnancy. National-level data on contemporary surgical practice and outcome is limited. To assess the clinical characteristics and outcomes of patients undergoing cholecystectomy during pregnancy. This cross-sectional study examined the Healthcare Cost and Utilization Project's two nationwide databases in the United States: National Inpatient Sample and Nationwide Ambulatory Surgery Sample. The study population was 18,630 patients who had cholecystectomy during pregnancy from 1/2016-12/2020. The exposure was gestational age, grouped sequentially into the following five groups: 1st-trimester (<14 weeks), early 2nd-trimester (14-20 weeks), late 2nd-trimester (21-27 weeks), early 3rd-trimester (28-36 weeks), and late 3rd-trimester (≥37 weeks). The main outcomes were clinical demographics, medical comorbidities, surgical information, and pregnancy characteristics and outcomes, assessed per gestational age. Cholecystectomy was most common in early 2nd-trimester (32.1%), followed by 1st-trimester (25.2%), late 2nd-trimester (23.1%), early 3rd-trimester (12.4%), and late 3rd-trimester (7.2%). Patients in the 1st-trimester group were more likely to be aged ≥35 years, smoker, have acute cholecystitis, severe hyperemesis gravidarum including metabolic disturbance, pregestational diabetes, multifetal gestation, and sepsis / shock (P<0.001). Patients in the early 3rd-trimester group were more likely to be obese, have gestational diabetes, Charlson Comorbidity Index of ≥1, premature rupture of membrane, and intrauterine growth restriction whereas those in the late 3rd-trimester were more likely to have gallstone pancreatitis, biliary colic, chorioamnionitis, gestational hypertension, pre-eclampsia, and severe maternal morbidity including sepsis (P<0.001). At the cohort-level, a laparoscopic approach was used in the majority of cholecystectomy procedures (97.5%), and bile duct injury was uncommon (<0.1%). Delivery during the admission occurred in 0.3%, 0%, 0.6%, 17.8%, and 60.6% of the five gestational age groups in sequence (P<0.001). Among the cases that had delivery in the early and late 3rd-trimester groups, the delivery event preceded cholecystectomy in 61.4% and 86.2%, respectively, whereas both delivery and cholecystectomy occurred in the same day in 34.3% and 13.8%, respectively. This nationwide analysis suggests that clinical and pregnancy characteristics and outcomes of patients undergoing cholecystectomy differ by pregnancy stage with a bimodal distribution: although patients in the 1st- and 3rd-trimesters have distinct medical conditions, clinically significant pregnancy and maternal outcomes occurred in both groups compared to the 2nd-trimester.

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