Planned cholecystectomy might be advisable in sickle cell disease

Last Updated: 2020-04-14

By David Douglas

NEW YORK (Reuters Health) - Because of the potential complications of urgent cholelithiasis in patients with sickle cell disease, pre-emptive surgery may be a sensible course, researchers say.

"There needs to be a change in the way we think about surgical management of sickle cell disease (SCD) in patients with gallbladder disease," said Dr. Asa Ramdath of Howard University Hospital, in Washington, D.C.

"Consideration should be given to elective cholecystectomy in this population including those that are asymptomatic," he told Reuters Health by email.

Cholecystectomy is the most commonly performed procedure in people with SCD, up to 85% of whom will be afflicted by gallstones by age 33 years, Dr. Ramdath and colleagues note in the Journal of the American College of Surgeons.

While many of these procedures "are done for symptomatic patients in urgent or semi-urgent settings, there are proponents of performing the procedure pre-emptively in asymptomatic patients," they write.

To examine this approach, the researchers studied data from the Nationwide Inpatient Sample (2005-2014) and identified close to 150,000 patients age 35 or younger who had undergone cholecystectomy, including 1,225 (0.82%) with SCD.

SCD was associated with significantly higher complication rates (2.69% vs. 1.12%) and a longer hospital stay (three vs. two days). Median hospital costs were also significantly higher in the SCD group.

Fifty-eight percent of SCD patients underwent cholecystectomy in the acute setting, while 42.0% did so electively. In the non-SCD group, the corresponding proportions were 87.0% and 13.0%.

When stratified by the level of acuity, complication rates were not significantly higher for SCD than non-SCD patients having elective surgery (0.98% vs. 1.95%, respectively). For acute presentations, however, SCD patients had significantly more complications (3.92% vs. 1.00%).

The researchers conclude that the data "suggest that SCD patients are at a unique disadvantage with regards to surgical outcomes when they are treated acutely. Therefore, the management principles that are applied to the general population may not be appropriate for SCD patients supporting the case for more pro-active surgical approaches towards gall bladder disease among this population."

SOURCE: https://bit.ly/3c9q3OQ Journal of the American College of Surgeons, online March 30, 2020.