Results
The total of 22 117 cholecystectomies comprise the final data set for this study accounting for 43 % all cholecystectomies (51 094) performed in Finland in 2002–2007. Of the included cholecystectomies, 78 % (17 175) were LCs and 22 % (4942) were OCs. The number of LCs and OCs by hospital district is shown in Fig. 2.
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Figure 2.
Number of laparoscopic cholecystectomies (LC) and open cholecystectomies (OC) by hospital districts in 2002 – 2007 (from hospital district J data available only from 2004 to 2007)
Demographic and perioperative data of the cholecystectomy patients is shown in Table 1. Compared to the OC patients, the LC patients were younger, more often female and more often belonged to the lower ASA classes. They also underwent an elective operation more often than the OC patients (88 % vs. 38 %, p < 0.001). The mean length of the operation was shorter for LCs than for OCs. Intraoperative cholangiographies (IOC) and common bile duct explorations were more common in the OC group. In addition, the mean length of hospital stay was longer and in-hospital mortality was higher among the OC patients (2.5 % vs. 0.3 %, p > 0.001).
The blood component use associated with LC and OC is shown in Table 2. Of the OC patients, as many as 16 % of patients received transfusion of any blood component compared to 1.6 % of the patients in the LC group. Similarly, the proportions of patient with RBC (13 % vs. 1.3 %, p < 0.001), PLT (1.2 % vs. 0.1 %, p < 0.001), FFP (4.9 % vs. 0.4 %, p < 0.001) and Octaplas® (0.9 % vs. 0.1 %, p < 0.001) transfusions were respectively higher in OC group compared to the LC group. Also the mean transfused dose of the FFP was significantly higher in the OC group compared to the LC groups. However, the mean transfused dose of the other blood components and the mean cost of the transfused blood components did not differ significantly between the groups (Table 2).
Massive transfusion refers to the administration of ten or more red blood cell units. In this cohort, 48 patients (0.002 %) received massive transfusion. Demographic and operative data of these patients is presented in Table 3. The mean age of the massive transfusion patients were 48 years and 33 (69 %) of them were female. Most of the cases (81 %) were related to OC and 72 % of the cases to emergent operations. In addition to RBCs, 78 % of the patients received fresh frozen plasma products (FFP or Octoplas®) and 46 % PLTs. The massive transfusions were associated with marked in-hospital mortality (15 %).