Optimal time for early laparoscopic cholecystectomy for acute cholecystitis

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Health Economics

Background:

• Early laparoscopic cholecystectomy (LC) for acute cholecystitis is increasingly supported.
• The optimal timing for early LC remains undefined, with definitions varying between 0 and 10 days.

Purpose of the Study:

• To assess if outcomes of early LC for acute cholecystitis differ based on presentation-to-surgery time.
• To determine the optimal timing for performing LC in acute cholecystitis cases.

Main Methods:

• Retrospective analysis of prospectively collected Nationwide Inpatient Sample (NIS) data (2005-2009).
• Included 95,523 adult patients undergoing LC within 10 days of acute cholecystitis presentation.
• Patients categorized into 0-1, 2-5, and 6-10 day groups; incremental day analysis (0-5) also performed.

Main Results:

• Surgery within 2-5 days and 6-10 days showed progressively worse outcomes compared to 0-1 day.
• Increased odds of mortality (1.26 and 1.93) and postoperative infections (0.88 and 1.53) in later groups.
• Mean hospital costs rose significantly with delay, from $8974 (0-1 day) to $17,745 (6-10 days).

Conclusions:

• Laparoscopic cholecystectomy within 48 hours of presentation yields optimal outcomes and cost-effectiveness.
• Delayed LC is associated with higher complication rates, mortality, and costs, though causality is not definitively established.