Impact of Heart Failure on Outcomes Following Laparoscopic Cholecystectomy for Acute Cholecystitis: A Propensity Score-Matched Analysis of the United States Nationwide Inpatient Sample.

Introduction: Few studies have examined outcomes of laparoscopic cholecystectomy for acute cholecystitis in patients with heart failure (HF). This study was to assess the impact of HF on cholecystectomy outcomes. Methods: Data from the United States Nationwide Inpatient Sample from 2016 to 2020 were examined. Adults ≥ 20-years-old diagnosed with acute cholecystitis who underwent laparoscopic cholecystectomy were included. Patients were categorized into groups with and without pre-existing HF. Results: Outcomes assessed included in-hospital mortality, non-routine discharge, length of hospital stay (LOS), total hospital cost, and complications. Propensity score matching (PSM) at a 1:1 ratio was conducted to balance between-group characteristics. Associations between HF and the outcomes were determined using univariate and multivariable regression analyses. After PSM, 11,646 patients were included in the analysis: 5,823 with HF and 5,823 without. Patients with HF had significantly elevated risks of in-hospital mortality (adjusted odds ratio [aOR] = 2.14, 95% confidence interval [CI]: 1.44, 3.17), non-routine discharge (aOR = 1.80, 95% CI: 1.61, 2.01), and complications (aOR = 1.51, 95% CI: 1.40, 1.63). Patients with HF also had longer LOS (1.52 days, 95% CI: 1.45, 1.60) and higher total hospital costs (16.64 thousand USD, 95% CI: 15.58, 17.70). The outcomes of HF patients were seen in those with HF reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Discussion: Patients with HF, either HFrEF or HFpEF, have increased risk of adverse inpatient outcomes following laparoscopic cholecystectomy for acute cholecystitis. This emphasizes the importance of tailored perioperative care to optimize patient outcomes.