Surgeons have hesitated early cholecystectomy because of cardiovascular comorbidities during adoption of guidelines

Area of Science:

• Gastroenterology
• Surgical Innovation
• Clinical Guidelines

Background:

• Acute cholecystitis management has evolved with guideline introductions.
• Laparoscopic cholecystectomy is the standard surgical approach.
• Assessing the real-world impact of clinical guidelines is crucial.

Purpose of the Study:

• To evaluate the initial effect of the Tokyo Guidelines on early laparoscopic cholecystectomy rates.
• To identify factors hindering timely surgical intervention for acute cholecystitis post-guideline introduction.

Main Methods:

• A single-center retrospective study of 141 acute cholecystitis patients (Jan 2010 - Oct 2014).
• Patients were divided into pre-guideline (Group A) and post-guideline (Group B) cohorts.
• Statistical analysis compared early surgery rates and influencing factors between groups.

Main Results:

• Early laparoscopic cholecystectomy significantly increased post-guideline introduction (P < 0.001).
• The overall rate of early surgery remained suboptimal at 38.7%.
• Coexisting cardiovascular disease (50% vs 24%, P < 0.01) and ongoing antiplatelet/anticoagulant therapy (approx. 25%) were significant factors in delayed surgery.

Conclusions:

• While the Tokyo Guidelines boosted early laparoscopic cholecystectomy, significant barriers to timely intervention persist.
• Cardiovascular disease is a primary factor delaying surgery for acute cholecystitis.
• Guideline revisions should address management strategies for patients with cardiovascular comorbidities to improve early surgical rates.