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Acute Cholecystitis: An Emerging Complication in Spinal Cord Injury Patients in the United States
Background Spinal cord injury (SCI) is a significant medical condition associated with various secondary complications, including cholelithiasis. Cholelithiasis can cause biliary duct obstruction and result in acute cholecystitis. The development of acute cholecystitis in SCI patients has been well studied in the Taiwanese population, showing an increased risk of acute cholecystitis in patients with SCI. The development of cholecystitis has not been well studied in the United States.
Materials and Methods A retrospective review was performed on 3,939 propensity score-matched patients aged 18 to 85 years who had SCI/surgery from 2000 to 2019. Patients were divided based on the development of postoperative complications, specifically cholecystitis with cholecystectomy.
Results SCI consisted of quadriplegia (42%), paraplegia (53%), unspecified lesion of cervical spinal cord (3%), and thoracic spinal cord (2%). All groups were comparable regarding age, gender, body mass index, smoking status, and Charlson comorbidity Index. The incidence of acute cholecystitis with subsequent cholecystectomy among patients with SCI was 43.0 per 10,000 person-years (95% confidence interval: 41.51–44.49). Median follow-up was 36 months. The development of cholecystitis was comparable among females (54.5%) and males (45.5%), and among African Americans (52.5%) and Caucasians (47.5%).
Conclusion There is an association between SCI and development of acute cholecystitis among U.S. patients. As SCI patients do not present with the classic signs of biliary colic, risk assessment for the development of acute cholecystitis will guide patient management and allow neurosurgeons to weigh the risks and benefits of prophylactic treatment for gallbladder complications.
Received: 30 March 2021
Accepted: 15 September 2021
Article published online:
29 May 2022
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- 1 Sezer N, Akkuş S, Uğurlu FG. Chronic complications of spinal cord injury. World J Orthop 2015; 6 (01) 24-33
- 2 McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ. Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil 1999; 80 (11) 1402-1410
- 3 Moonka R, Stiens SA, Resnick WJ. et al. The prevalence and natural history of gallstones in spinal cord injured patients. J Am Coll Surg 1999; 189 (03) 274-281
- 4 Xia CS, Han YQ, Yang XY, Hong GX. Spinal cord injury and cholelithiasis. Hepatobiliary Pancreat Dis Int 2004; 3 (04) 595-598
- 5 Rotter KP, Larraín CG. Gallstones in spinal cord injury (SCI): a late medical complication?. Spinal Cord 2003; 41 (02) 105-108
- 6 Ketover SR, Ansel HJ, Goldish G, Roche B, Gebhard RL. Gallstones in chronic spinal cord injury: is impaired gallbladder emptying a risk factor?. Arch Phys Med Rehabil 1996; 77 (11) 1136-1138
- 7 Indar AA, Beckingham IJ. Acute cholecystitis. BMJ 2002; 325 (7365): 639-643
- 8 Hsu CL, Wang MT, Ho YC, Pan SL. Increased risk of acute cholecystitis in patients with spinal cord injury: a nationwide population-based cohort study. Spine 2018; 43 (13) 934-939
- 9 Bellin E. Riddles in Accountable Healthcare: A Primer to Develop Analytic Intuition for Medical Homes and Population Health. North Charleston, SC: CreateSpace Independent Publishing Platform; 2015
- 10 Bellin E, Fletcher DD, Geberer N, Islam S, Srivastava N. Democratizing information creation from health care data for quality improvement, research, and education: the Montefiore Medical Center Experience. Acad Med 2010; 85 (08) 1362-1368