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Early versus delayed laparoscopic cholecystectomy for gallbladder perforation
Renqing Wu1, Ryan P Dumas, Vanessa Nomellini
1From the Division of Burn, Trauma, Acute, and Critical Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.
Insights
Early laparoscopic cholecystectomy for gallbladder perforation significantly reduces total hospital length of stay (THLOS) without impacting other outcomes. Prompt surgical intervention within two days of admission is recommended for improved patient management.
Area of Science:
- Surgical outcomes research
- Gastrointestinal surgery
- Acute care surgery
Background:
- Gallbladder perforation is a severe complication of acute cholecystitis with high mortality.
- Management strategies for perforated cholecystitis lack robust evidence, particularly regarding operative timing.
- This study investigates the impact of early versus delayed cholecystectomy on patient outcomes.
Purpose of the Study:
- To evaluate the association between early (<2 days) versus delayed (≥2 days) laparoscopic cholecystectomy and total hospital length of stay (THLOS) in patients with gallbladder perforation.
- To compare other postoperative outcomes, including complications, readmission, and reoperation rates, between early and delayed surgical intervention.
- To provide evidence-based recommendations for the optimal timing of surgery in perforated cholecystitis.
Main Methods:
- Analysis of the National Surgical Quality Improvement Program database (2012-2021).
- Identification of patients undergoing urgent or emergent laparoscopic cholecystectomy for gallbladder perforation.
- Multivariate regression models used to compare THLOS between early and delayed cholecystectomy groups, adjusting for preoperative sepsis status.
Main Results:
- Delayed cholecystectomy was associated with a significantly longer THLOS (2.94 days increase, p < 0.05).
- For patients without preoperative sepsis, delayed surgery resulted in an even greater increase in THLOS (4.71 days, p < 0.05).
- No significant differences were observed in postoperative length of stay, 30-day complications, readmission, or reoperation rates between the early and delayed groups.
Conclusions:
- Early laparoscopic cholecystectomy (<2 days from admission) is associated with a reduced total hospital length of stay for gallbladder perforation.
- There were no significant differences in other key postoperative outcomes between early and delayed surgical management.
- An early operative approach within two days of admission is likely beneficial for patients with gallbladder perforation.
Background:
Gallbladder perforation occurs in 2% to 11% of patients with acute cholecystitis, with associated mortality estimated to be at 12% to 42%. Because of its low incidence, the data on management remain sparse. There is a lack of evidence to suggest whether early or delayed cholecystectomy is superior in the treatment of perforated cholecystitis. We hypothesize that an early definitive operation is associated with decreased total hospital length of stay (THLOS).
Methods:
Using the National Surgical Quality Improvement Program database from the American College of Surgery, we identified patients who underwent laparoscopic cholecystectomy for gallbladder perforation on an urgent or emergent basis from 2012 to 2021. We divided them into those who underwent early (<2 days from the date of admission to the date of operation) and delayed cholecystectomy (≥2 days from the date of admission to the date of operation). Our primary outcome was the THLOS. We created multivariate regression models to assess for the association of early versus delayed operation and THLOS.
Results:
The THLOS was found to be 2.94 days longer in the delayed group compared with the early group (p < 0.05). In those who did not present with sepsis on admission, the THLOS was noted to be 4.71 days longer in the delayed group compared with the early group (p < 0.05). Early versus delayed operation was not associated with a difference in the postoperative length of stay, 30-day postoperative complications, rate of readmission, and reoperation, regardless of preoperative sepsis status.
Conclusion:
Early laparoscopic cholecystectomy for gallbladder perforation is associated with decreased THLOS, and there were no other differences in outcomes compared with delayed laparoscopic cholecystectomy. Patients with gallbladder perforation would likely benefit from an early operation within 2 days of admission.
Level Of Evidence:
Therapeutic/Care management; Level IV.
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