Race Is a Predictor of In-Hospital Mortality After Cholecystectomy, Especially in Those With Portal Hypertension

Background & Aims: Cholecystectomy is the most frequently performed gastrointestinal surgery in the United States. In this study, we characterized racial disparities in in-hospital mortality after cholecystectomy among patients with and without decompensated cirrhosis. Methods: All patients who underwent cholecystectomy between 1998 and 2003 were queried from the Nationwide Inpatient Sample, the largest population-based and geographically representative all-payer database of hospital discharges in the United States. Crude mortality among races was determined for those with and without cirrhosis with portal hypertension and subsequently adjusted for demographic and clinical factors. Results: In-hospital mortality associated with cholecystectomy was higher in the portal hypertensive group compared with those without portal hypertension (10.8% vs 1.4%; P < .0001). African Americans had greater adjusted mortality risk than whites in both the nonportal hypertensive (odds ratio [OR], 1.48; 95% CI, 1.35-1.63) and portal hypertensive (odds ratio [OR], 2.37; 95% CI, 1.47-3.84) groups, although the mortality gap was more pronounced in the latter. For portal hypertensive patients, undergoing cholecystectomy at a liver transplant center was associated with dramatically lower mortality (OR, 0.41; 95% CI, 0.25-0.69). Conclusions: In-patient mortality after cholecystectomy is 7.8-fold higher in patients with portal hypertension compared with those without portal hypertension. African Americans experienced higher mortality than whites after cholecystectomy, especially in the presence of portal hypertension. Cholecystectomy at a liver transplant center may offer survival benefit for patients with portal hypertension.