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Outcomes after early vs interval cholecystectomy for perforated Cholecystitis:A multicenter cohort study

Janelle Cyprich¹, Isabela Sandigo-Saballos¹, Angela Neville¹

¹Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA, USA.

American Journal of Surgery

|July 25, 2025

Abstract

Introduction:

Gallbladder perforation is rare and carries significant morbidity. The optimal timing of cholecystectomy in patients with perforated cholecystitis is debated.

Methods:

A multi-institutional retrospective review of patients undergoing cholecystectomy for perforated cholecystitis from 2014 to 2023 was performed. Presenting characteristics, operative details, and short-term outcomes were compared between patients undergoing early (same-admission) vs interval cholecystectomy.

Results:

Of 230 patients included, 201 (87.4 %) underwent early cholecystectomy (EC), while 29 (12.6 %) underwent interval cholecystectomy (IC). Patients undergoing IC were more likely to require an open surgery (55.2 % vs 35.3 %, p = 0.04) and more likely to develop a surgical site infection (17.2 % vs 4.0 %, p = 0.01), even after adjusting for surgical approach (aOR 3.8, 95 % CI 1.1-13.3, p = 0.04). Total hospital length of stay (including index hospitalizations in the IC group) was longer for patients undergoing IC (median 8 days vs 5 days, p = 0.02). Thirty-day biliary complications, reinterventions, and readmissions were similar between groups.

Conclusion:

Our study suggests EC for perforated cholecystitis is safe and may be preferable to IC with fewer open surgeries, surgical site infections, and shorter overall hospital stay.

Keywords:

Early cholecystectomy Gallbladder perforation Perforated cholecystitis

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