Age-adjusted charlson comorbidity index associated with post-cholecystectomy short-term outcomes

Background: Frailty indexes (Charlson comorbidity index, CCI, age-adjusted Charlson, AACCI) and cholecystectomy outcomes have scarcely been analysed in recent literature. Patients and Methods: Prospective observational study including consecutive cholecystectomies performed by single young HPB surgeon or his supervised trainees from July 2017 to November 2018. Main outcomes: conversion to open surgery, postoperative immediate admission at Surgical Intensive Care Unit (SICU), postoperative morbidity (thoroughly registered according to Clavien´s classification) up to discharge, length of stay (LOS). Different preoperative variables were tested, including CCI, AACCI, type of procedure. Results: 60 patients, 60.4±15.5 year-old, males 38.3%. BMI: 27.2±4.1 Kg/m2 (38.3% lost data, thus excluded for analysis). CCI: 0.37±0.64, AACCI: 1.95±1.55. Emergent cholecystectomies: 20%. Initial laparoscopic approach: 98.3%(n=59). Conversion: 15.3%(n=9/59). ICU admission: 3.4%. Morbidity: Clavien I 26.7% (mostly were increased pain and postoperative nausea/vomiting), Clavien II 5.0%. Median LOS: 2 days (IQR=1-3). Re-admission: n=1 (1.7%, residual choledocholithiasis). Age, CCI and AACCI showed no statistical differences for elective/emergent surgery, initial laparoscopic approach, conversion, overall morbidity. Higher CCI and AACCI were found in patients admitted at SICU: 0.32±0.57 vs. 2.00±0 (p<0.001) and 1.84±1.47 vs. 5.00±1.41 (p=0.004). Older age was found among patients suffering Clavien II vs. Clavien I morbidity: 59.4±13.3 vs. 81.3±8.3 (p=0.019), as well as higher AACCI: 2.00±1.51 vs. 4.33±1.53 (p=0.047). Weak but significant correlation was found between age and LOS: r=0.281 (p=0.031), as well as AACCI: r=0.265 (p=0.042). Longer LOS was associated with emergent cholecystectomy (median 3 vs. 1 days,p<0.001) and conversion (median 4 vs. 1 days,p<0.001). Besides, conversion itself was associated with SICU admission (0% vs 22%,p=0.022) and non-statistically with Clavien II morbidty (7.1% vs. 50%, p=0.1) Conclusions: We confirm that frailty indexes, particularly AACCI, are associated with worse short-term outcomes after cholecystectomy (immediate SICU admission, Clavien II morbidity, longer LOS). Conversion, but not emergency surgery, may also play a role.