Outcomes after index cholecystectomy: a UK longitudinal multi-centre cohort Study

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Health Services Research

Background:

• International guidelines recommend emergency cholecystectomy (EmC) for acute biliary pathology.
• This recommendation is based on trials that may not reflect real-world clinical capacity constraints.
• Patient selection for EmC may be influenced by prior emergency visits or decisions for elective surgery.

Purpose of the Study:

• To evaluate the justification of EmC in the context of clinical practice.
• To assess outcomes of EmC versus elective cholecystectomy (ElC) considering patient history and healthcare system capacity.
• To analyze time to surgery, re-attendance rates, and length of stay.

Main Methods:

• Longitudinal retrospective study of 2,056 patients undergoing cholecystectomy between 2016 and 2021 across four centers.
• Patients with emergency presentations of biliary pathology prior to surgery were included.
• Multilevel regression modeling identified predictors for time to surgery, re-attendance, and length of stay (LoS).

Main Results:

• EmC (13.1% of cases) was associated with a significant reduction in time to surgery (-112.32 days).
• However, EmC led to a significant increase in post-operative and overall LoS (+3.34 days).
• EmC did not significantly reduce emergency re-attendance rates prior to surgery.

Conclusions:

• While EmC expedites surgery, it increases length of stay and fails to reduce emergency re-attendance.
• Limited emergency theatre capacity necessitates prioritizing patients who gain the most benefit from EmC.
• The findings suggest a need to re-evaluate EmC protocols in resource-constrained environments.