Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Feb;281(2):312-321.
doi: 10.1097/SLA.0000000000006236. Epub 2024 Feb 13.

30-day Morbidity and Mortality after Cholecystectomy for Benign Gallbladder Disease (AMBROSE): A Prospective, International Collaborative Cohort Study

Geoffrey Yuet Mun Wong  1 , Himanshu Wadhawan  2 , Victor Roth Cardoso  3 , Laura Bravo Merodio  3 , Yashasvi Rajeev  4 , Ricardo David Maldonado  5 , Alessandro Martinino  6 , Vignesh Balasubaramaniam  7 , Aabid Ashraf  8 , Adeela Siddiqui  9 , Ahmad Ghassan Al-Shkirat  10 , Ahmed Mohammed Abu-Elfatth  11 , Ajay Gupta  12 , Akram Alkaseek  13 , Amel Ouyahia  14 , Amira Said  15 , Anshuman Pandey  16 , Ashwani Kumar  17 , Baila Maqbool  18 , Carlos Alberto Millán  19 , Cheena Singh  8 , Diana Alejandra Pantoja Pachajoa  20 , Dmitry Mikhailovich Adamovich  21 , Enrique Petracchi  22 , Fariha Ashraf  23 , Marco Clementi  24 , Francesk Mulita  25 , Gad Amram Marom  26 , Gamaleldeen Abdulaal  27 , Georgios-Ioannis Verras  28 , Giacomo Calini  29 , Gianluigi Moretto  30 , Hossam Elfeki  31 , Hui Liang  32 , Humam Jalaawiy  33 , Ibrahim Elzayat  34 , Jayanta Kumar Das  35 , Jose Miguel Aceves-Ayala  36 , Kazi T Ahmed  15 , Luca Degrate  37 , Manisha Aggarwal  38 , Mohammed Ahmed Omar  39 , Mounira Rais  40 , Muhammed Elhadi  41 , Nasser Sakran  42 , Rajesh Bhojwani  43 , Ramesh Agarwalla  44 , Samir Kanaan  45 , Sarnai Erdene  46 , Serge Chooklin  47 , Suhail Khuroo  48 , Surrendar Dawani  9 , Syed Tanseer Asghar  49 , Tak Kwan James Fung  50 , Taryel Omarov  51 , Valentin Titus Grigorean, Zdenko Boras  52 , Georgios V Gkoutos  53 , Rishi Singhal  54 , Kamal Mahawar  55 ; AMBROSE Collaborative
Collaborators, Affiliations
Observational Study

30-day Morbidity and Mortality after Cholecystectomy for Benign Gallbladder Disease (AMBROSE): A Prospective, International Collaborative Cohort Study

Geoffrey Yuet Mun Wong et al. Ann Surg. 2025 Feb.

Abstract

Objective: This study aimed to assess 30-day morbidity and mortality rates following cholecystectomy for benign gallbladder disease and identify the factors associated with complications.

Summary background data: Although cholecystectomy is common for benign gallbladder disease, there is a gap in the knowledge of the current practice and variations on a global level.

Methods: A prospective, international, observational collaborative cohort study of consecutive patients undergoing cholecystectomy for benign gallbladder disease from participating hospitals in 57 countries between January 1 and June 30, 2022, was performed. Univariate and multivariate logistic regression models were used to identify preoperative and operative variables associated with 30-day postoperative outcomes.

Results: Data of 21,706 surgical patients from 57 countries were included in the analysis. A total of 10,821 (49.9%), 4,263 (19.7%), and 6,622 (30.5%) cholecystectomies were performed in the elective, emergency, and delayed settings, respectively. Thirty-day postoperative complications were observed in 1,738 patients (8.0%), including mortality in 83 patients (0.4%). Bile leaks (Strasberg grade A) were reported in 278 (1.3%) patients and severe bile duct injuries (Strasberg grades B-E) were reported in 48 (0.2%) patients. Patient age, ASA physical status class, surgical setting, operative approach and Nassar operative difficulty grade were identified as the five predictors demonstrating the highest relative importance in predicting postoperative complications.

Conclusion: This multinational observational collaborative cohort study presents a comprehensive report of the current practices and outcomes of cholecystectomy for benign gallbladder disease. Ongoing global collaborative evaluations and initiatives are needed to promote quality assurance and improvement in cholecystectomy.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Forest plot of multivariate analysis for preoperative and operative factors associated with complications after cholecystectomy for benign gallbladder disease.
See this image and copyright information in PMC

References

    1. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6:172–187. - PMC - PubMed
    1. Russo MW, Wei JT, Thiny MT, et al. . Digestive and liver diseases statistics, 2004. Gastroenterology. 2004;126:1448–1453. - PubMed
    1. Lammert F, Gurusamy K, Ko CW, et al. . Gallstones. Nat Rev Dis Primers. 2016;2:16024. - PubMed
    1. Miura F Takada T Strasberg SM et al. . Tokyo Guidelines Revision Committee . TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20:47–54. - PubMed
    1. Ansaloni L, Pisano M, Coccolini F, et al. . 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg. 2016;11:25. - PMC - PubMed

Publication types