Impact of inflammatory bowel disease on post-cholecystectomy complications and hospitalization costs: A Nationwide Inpatient Sample study

Our previous single-center study showed that patients with underlying inflammatory bowel disease (IBD) had a higher risk for post-cholecystectomy complications. The aim of the current population-based study was to verify whether concomitant IBD was indeed associated with an increased risk of post-cholecystectomy complications. In this cross-sectional study, all 1,155,432 patients from the Nationwide Inpatient Sample (NIS) with a primary procedure of cholecystectomy were examined, and 5891 patients with IBD were compared with 1,149,541 patients without IBD from 2006 to 2008. There were no significant differences in age, gender, frequency of obesity, and post-operative mortality between the two groups. More patients in the IBD group had post-operative complications than the non-IBD group [398/5891 (6.8%) vs. 55,202/1,149,541 (4.8%), p=0.002)]. On multivariate analysis, the presence of Crohn's disease (CD) was associated with an increased risk for post-operative complications (odds ratio [OR]=1.6; 95% confidence interval [CI], 1.2–2.1, p=0.003). The other risk factors for post-cholecystectomy complications were older age, male gender, African-American race, malnutrition and patients with higher co-morbidity index. The presence of ulcerative colitis (UC) was associated with a trend for increased complications (OR=1.3, 95% CI 0.8–2.1, p=0.08). Patients with IBD who underwent cholecystectomy incurred higher mean hospital costs ($39,651 vs. $35,196, p=0.006) and also stayed in the hospital 1.2days longer than those without underlying IBD. CD patients undergoing cholecystectomy were shown to have a significantly increased risk for postoperative complications, have a longer stay in the hospital, and incur higher hospitalization costs.