S2594 Outcomes and Trends in Cholecystectomy Among Patients with Cirrhosis: A National Retrospective Cohort Study

Introduction: Cirrhosis is a known risk factor for adverse surgical outcomes, yet national data on cholecystectomy (CCY) in this population remain limited. We evaluated operative outcomes, readmissions and contemporary trends among cirrhotic patients undergoing CCY. Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database (2016–2019). Adults undergoing inpatient CCY were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes and stratified by the presence of cirrhosis and operative approach (laparoscopic vs open). Multivariable regression models were used for outcome analysis. Results: Among 1,941,642 hospitalizations for CCY, 41,724 (2.2%) patients had cirrhosis. Gallbladder-related disease (cholecystitis, cholangitis, or cholelithiasis) was the most common indication in both groups (80.4% in cirrhosis vs 86.7% without). Cirrhotic patients had higher in-hospital mortality (2.62% vs 0.80%; adjusted odds ratio (AOR) 1.88; P < 0.001), more complications, increased admission to the intensive care unit, longer length of stay, and higher hospitalization charges (P < 0.001). Thirty-day readmissions were more frequent in patients with cirrhosis (10.87% vs 5.32%; adjusted hazard ratio 1.54, P < 0.001), most commonly due to cirrhosis-related decompensation. Use of laparoscopic CCY in cirrhotics increased from 64.4% in 2016 to 71.0% in 2019 (P = 0.018). Among cirrhotics, open CCY was associated with significantly higher mortality and complications compared to laparoscopic CCY, though readmission rates were similar. Conclusion: Cirrhosis is independently associated with adverse outcomes following CCY. While laparoscopic CCY is increasingly adopted and offers favorable perioperative outcomes, cirrhosis remains one of the key drivers of morbidity and readmission. These findings emphasize the importance of individualized risk assessment, careful patient selection, and coordinated perioperative care to improve outcomes in this population.