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No link between abnormal liver function tests, cholecystectomy outcomes in acute cholecystitis
LAS VEGAS — Patients with acute cholecystitis and elevated liver function tests had similar cholecystectomy outcomes but longer hospital stays compared with patients with normal test results, according to data presented at the 2012 of Gastroenterology Annual Scientific Meeting.
Researchers assessed 207 patients who received cholecystectomy for acute cholecystitis between January 2005 and January 2010, including 107 with normal liver function tests (LFTs) and 100 with elevated LFTs.
“Current guidelines suggest that, in the setting of acute cholecystitis, early cholecystectomy may be performed within 24 to 72 hours of diagnosis,” the researchers wrote. “When elevated [LFTs] are present, a cholangiogram is frequently obtained to rule out choledocholithiasis, [which] inevitably delays surgery. We hypothesized that patients with elevated LFTs and a normal cholangiogram might represent a group with more severe acute cholecystitis and, hence, anticipated different outcomes … compared to a group of patients with normal LFTs.”
Investigators noted that the length of hospital stay was longer among patients with abnormal LFTs (4.65 days compared with 3.9 days; P=.004), particularly prior to the procedure (1.5 days compared with 1.2 days). In this group specifically, patients with elevated LFTs who underwent preoperative cholangiograms had significantly longer total stays (6 days compared with 4.4 days) and preoperative stays (3.2 days compared with 1.2 days) than those who did not receive cholangiograms.
The two groups did not significantly differ according to age or sex, or clinical variables.
“When you see a patient with acute cholecystitis who had abnormal LFTs … we can safely say that they’re OK to go for surgery,” researcher Venkata C. Gourineni, MD, chief resident at Bridgeport Hospital in Bridgeport, Conn., told Healio.com. “The guidelines recommend [that] patients should go for surgery within 24-72 hours. But [according to] our study, the preoperative period is delayed because they’re going on to have investigations because of the abnormal LFTs, though they’re not sick preoperatively and had no postoperative complications afterward. If you’re worried about elevated LFTs, utilization of the investigations in a timely manner might reduce the length of stay for patients with acute cholecystitis.”
For more information:
Gourineni VC. P1341: Do Patients With Acute Cholecystitis With Elevated Liver Function Tests and a Normal Cholangiogram Have Different Outcomes Than Those With Normal Liver Function Tests? Presented at: the 2012 American College of Gastroenterology Annual Scientific Meeting; Oct. 19-24, Las Vegas.