Incidence, Risk Factors, and Time Trends for Bile Leakage After Cholecystectomy for Gallstone Disease-Results From a Population-Based Cohort Study.

Abstract

Bile leakage is a severe complication after cholecystectomy and is associated with an increased risk of morbidity and mortality. The aim of this study was to evaluate the incidence of bile leakage post-cholecystectomy and to identify potential risk factors and their association with changes in the incidence of bile leakage over time. Demographic and perioperative data of all patients who underwent cholecystectomy in Sweden between 2006 and 2019 were retrieved from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). Data on the occurrence of bile leakage within 30 days were recorded and risk factors were identified using uni- and multivariable logistic regression analyses. Bile leakage occurred in 1738 of the 152,413 patients who underwent cholecystectomy, resulting in an overall incidence of 1.14%. The incidence was relatively consistent over the study period. ASA-score II and III, emergent surgery, open cholecystectomy, conversion from laparoscopic to open technique, bleeding requiring intervention, not performing, or incomplete intraoperative cholangiography (IOC) were identified as risk factors for bile leakage. The proportion of ASA II and ASA III patients undergoing cholecystectomy increased over time (p < 0.001). There was also a significant increase in the proportions of emergent cholecystectomies from 27.9% to 43.6% (p < 0.001) and surgery for complicated gallstone disease from 35.4% to 52.5% (p < 0.001) during the study period. The incidence of bile leakage was relatively consistent over the study period despite an observed increase in the prevalence of identified risk factors of bile leakage.