Risk Factors Determinants of Subtotal Cholecystectomy: Experience at a Second-Level Hospital in Mexico.
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Abstract
Objective: To identify the clinical and surgical factors associated with performing subtotal cholecystectomy in patients undergoing surgery for cholecystitis at the General Hospital of Cancún, in order to anticipate cases of greater surgical complexity, improve preoperative planning, and reduce the risk of complications.
Methods: A search was conducted of the records of patients who underwent total or subtotal cholecystectomy from January 2023 to December 2024. Chi-square and Student's t-tests were applied to compare between both groups. This was complemented with multivariate regression to adjust for possible confounding factors.
Results: A total of 385 patients were analyzed, of whom 345 (89.6%) underwent total cholecystectomy and 40 (10.4%) underwent subtotal cholecystectomy. Patients with subtotal cholecystectomy were older (44.8 ± 16.8 vs. 38.8 ± 14.1 years, p = 0.033) and heavier (76.46 ± 17.14 vs. 70.19 ± 15.02 kg, p = 0.034). They were also associated with greater gallbladder wall thickness (5.9 ± 2.5 vs. 4.0 ± 2.3 mm, p < 0.001) and a higher white blood cell count (13.1 ± 5.10 vs. 10.5 ± 6.23 cells/ml, p = 0.005).
Conclusions: Subtotal cholecystectomy was significantly associated with factors suggesting greater complexity of the condition, such as older age, greater weight, presence of diabetes, and wall thickening. Identifying these preoperative factors could help anticipate the need for a subtotal technique and optimize surgical preparation.
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