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Consequences of prolonged wait before gallbladder surgery.

C V N Cheruvu1, I A Eyre-Brook

  • 1Department of Surgery, Taunton & Somerset Hospital, Taunton, UK.

Annals of the Royal College of Surgeons of England
|March 15, 2002
PubMed
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Long waits for laparoscopic cholecystectomy increase morbidity, especially for emergency admissions. Early surgery for symptomatic gallstones is recommended to reduce complications and hospital stays.

Area of Science:

  • Gastroenterology
  • Surgical Outcomes
  • Health Services Research

Background:

  • Long waiting times for laparoscopic cholecystectomy are a concern in healthcare systems with limited operating capacity.
  • Gallstone disease can lead to significant morbidity, including acute cholecystitis, biliary colic, jaundice, cholangitis, and pancreatitis.

Purpose of the Study:

  • To document the morbidity associated with prolonged waiting times for laparoscopic cholecystectomy.
  • To compare morbidity based on initial patient presentation: routine outpatient consultation versus emergency admission.

Main Methods:

  • A 50-month retrospective study of 365 patients undergoing laparoscopic cholecystectomy.
  • Patients were categorized into an elective outpatient cohort (n=246) and an emergency admission cohort (n=119).

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  • Data collected on waiting times, emergency admissions for complications, and hospital stay.

    • Main Results:

    • Median waiting time was 170 days.
    • 11.5% of patients experienced gallstone-related complications while awaiting surgery.
    • Emergency cohort had significantly higher re-admission rates (28.5%) compared to the elective cohort (2.8%).
    • Median total and postoperative hospital stays were shorter for the elective cohort.

    Conclusions:

    • Prolonged waiting lists for laparoscopic cholecystectomy lead to substantial patient morbidity.
    • Patients initially presenting with acute symptoms have the highest risk of complications and re-admissions.
    • Offering early cholecystectomy to emergency presentations of symptomatic gallstones is advisable to mitigate morbidity.