30-day Morbidity and Mortality After Cholecystectomy for Benign Gallbladder Disease (AMBROSE)
Authors: Wong Geoffrey Yuet Mun , Wadhawan Himanshu , Roth Cardoso Victor , Bravo Merodio Laura , Rajeev Yashasvi , Maldonado Ricardo David , Martinino Alessandro , Balasubaramaniam Vignesh , Ashraf Aabid , Siddiqui Adeela , Al-Shkirat Ahmad Ghassan , Mohammed Abu-Elfatth Ahmed , Gupta Ajay , Alkaseek Akram , Ouyahia Amel , Said Amira , Pandey Anshuman , Kumar Ashwani , Maqbool Baila , Millán Carlos Alberto , Singh Cheena , Pantoja Pachajoa Diana Alejandra , Adamovich Dmitry Mikhailovich , Petracchi Enrique , Ashraf Fariha , Clementi Marco , Mulita Francesk , Marom Gad Amram , Abdulaal Gamaleldeen , Verras Georgios-Ioannis , Calini Giacomo , Moretto Gianluigi , Elfeki Hossam , Liang Hui , Jalaawiy Humam , Elzayat Ibrahim , Das Jayanta Kumar , Aceves-Ayala Jose Miguel , Ahmed Kazi T. , Degrate Luca , Aggarwal Manisha , Omar Mohammed Ahmed , Rais Mounira , Elhadi Muhammed , Sakran Nasser , Bhojwani Rajesh , Agarwalla Ramesh , Kanaan Samir , Erdene Sarnai , Chooklin Serge , Khuroo Suhail , Dawani Surrendar , Asghar Syed Tanseer , Fung Tak Kwan James , Omarov Taryel , Grigorean Valentin Titus , Boras Zdenko , Gkoutos Georgios V. , Singhal Rishi , Mahawar Kamal ,   AMBROSE Collaborative
Published: February 2024

Objective:
This study aimed to assess 30-day morbidity and mortality rates following cholecystectomy for benign gallbladder disease and identify the factors associated with complications.

Background:
Although cholecystectomy is common for benign gallbladder disease, there is a gap in the knowledge of the current practice and variations on a global level.

Methods:
A prospective, international, observational collaborative cohort study of consecutive patients undergoing cholecystectomy for benign gallbladder disease from participating hospitals in 57 countries between January 1 and June 30, 2022, was performed. Univariate and multivariate logistic regression models were used to identify preoperative and operative variables associated with 30-day postoperative outcomes.

Results:
Data of 21,706 surgical patients from 57 countries were included in the analysis. A total of 10,821 (49.9%), 4263 (19.7%), and 6622 (30.5%) cholecystectomies were performed in the elective, emergency, and delayed settings, respectively. Thirty-day postoperative complications were observed in 1738 patients (8.0%), including mortality in 83 patients (0.4%). Bile leaks (Strasberg grade A) were reported in 278 (1.3%) patients, and severe bile duct injuries (Strasberg grades B–E) were reported in 48 (0.2%) patients. Patient age, American Society of Anesthesiologists physical status class, surgical setting, operative approach, and Nassar operative difficulty grade were identified as the 5 predictors demonstrating the highest relative importance in predicting postoperative complications.

Conclusions:
This multinational observational collaborative cohort study presents a comprehensive report of the current practices and outcomes of cholecystectomy for benign gallbladder disease. Ongoing global collaborative evaluations and initiatives are needed to promote quality assurance and improvement in cholecystectomy.