Predictive Factors for a Long Postoperative Stay after Emergency Laparoscopic Cholecystectomy Using the 2013 Tokyo...

Area of Science:

• Gastroenterology
• Surgical Innovation
• Health Services Research

Background:

• Laparoscopic cholecystectomy (LC) is a standard treatment for acute cholecystitis (AC).
• Predicting postoperative hospital stays (PHS) is essential for resource management and patient care.
• The 2013 Tokyo Guidelines (TG13) provide a framework for AC management.

Purpose of the Study:

• To identify and evaluate risk factors for prolonged PHS in patients undergoing emergency LC for AC.
• To stratify patient risk for extended hospital stays based on preoperative and perioperative factors.

Main Methods:

• Retrospective analysis of clinical data from 149 patients undergoing emergency LC for AC (2011-2017).
• Patients categorized into early discharge (≤3 days) and late discharge (>3 days) groups.
• Preoperative characteristics and perioperative outcomes analyzed for association with late discharge.

Main Results:

• 30.2% of patients experienced prolonged PHSs, with fever and inflammation being primary causes.
• Univariate analysis identified age, white blood cell count, C-reactive protein, total bilirubin (T-bil), alkaline phosphatase (ALP), anticoagulation, and TG13 severity grade as significant.
• Multivariate analysis confirmed TG13 severity grade II, age >65 years, and elevated T-bil and ALP levels as independent predictors of prolonged PHS.

Conclusions:

• Older age, impaired biliary function (elevated T-bil and ALP), and higher TG13 severity grade are significant predictors of prolonged PHS in AC patients undergoing emergency LC.
• These factors can aid in predicting prolonged hospital stays, enabling better preoperative planning and patient management.
• Optimizing management strategies for high-risk patients may reduce PHS and associated healthcare costs.