Objective: To compare clinical outcomes after laparoscopic cholecystectomy (LC) for acute cholecystitis performed at various time-points after hospital admission.
Background: Symptomatic gallstones represent an important public health problem with LC the treatment of choice. LC is increasingly offered for acute cholecystitis, however, the optimal time-point for LC in this setting remains a matter of debate.
Methods: Analysis was based on the prospective database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery and included patients undergoing emergency LC for acute cholecystitis between 1995 and 2006, grouped according to the time-points of LC since hospital admission (admission day (d0), d1, d2, d3, d4/5, d ≥6). Linear and generalized linear regression models assessed the effect of timing of LC on intra- or postoperative complications, conversion and reoperation rates and length of postoperative hospital stay.
Results: Of 4113 patients, 52.8% were female, median age was 59.8 years. Delaying LC resulted in significantly higher conversion rates (from 11.9% at d0 to 27.9% at d ≥6 days after admission, P < 0.001), surgical postoperative complications (5.7% to 13%, P < 0.001) and re-operation rates (0.9% to 3%, P = 0.007), with a significantly longer postoperative hospital stay (P < 0.001).
Conclusions: Delaying LC for acute cholecystitis has no advantages, resulting in significantly increased conversion/re-operation rate, postoperative complications and longer postoperative hospital stay. This investigation—one of the largest in the literature—provides compelling evidence that acute cholecystitis merits surgery within 48 hours of hospital admission if impact on the patient and health care system is to be minimized.
Symptomatic gallstones represent a major public health problem and many patients present with acute cholecystitis. However, the optimal time-point for laparoscopic cholecystectomy in this setting remains a matter of great debate. Our population based analysis of over 4000 patients provides compelling evidence that delaying laparoscopic cholecystectomy in patients with acute cholecystitis has no advantages and actually results in significantly increased postoperative complications, a higher conversion-rate, higher risk of re-operation and longer postoperative hospital stay.
*Department of Visceral Surgery and Medicine, Inselspital, University Hospital Berne and University of Berne, CH-3010 Berne, Switzerland
†Institute for Social and Preventive Medicine, University of Berne, Switzerland.
Reprints: Ulrich Güller, MD, MHS, Department of Visceral Surgery and Medicine, Inselspital, University Hospital Berne, CH-3010 Berne, Switzerland. E-mail: firstname.lastname@example.org.
Disclosure: The authors declare that they have nothing to disclose.
This study was presented at the Annual Meeting of the Swiss Surgical Society in Interlaken, Switzerland, May 26th–28th 2010 and at the Annual Meeting of the European Association of Endoscopic Surgery in Geneva, Switzerland, June 16th–19th 2010.
Supported by grants from Johnson & Johnson and Covidien.