Complications associated with late acute cholecystectomy

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Public Health

Background:

• Gallstone disease and acute cholecystitis are prevalent in Denmark.
• Historically, cholecystectomy was recommended within five days of symptom onset.
• Recent guidelines removed this time limit, prompting an evaluation of its impact.

Purpose of the Study:

• To assess the effect of an extended surgical window on acute cholecystitis operations.
• To analyze complication rates and patient outcomes following delayed cholecystectomy.
• To evaluate the impact of guideline changes on surgical practices for gallstone disease.

Main Methods:

• Retrospective review of cholecystectomies performed between June 2022 and May 2023.
• Identification of 128 eligible patients using procedural codes KJKA20 and KJKA21.
• Exclusion of patients with gallstone pancreatitis, biliary colic, or choledocholithiasis.

Main Results:

• Thirty-nine of 128 patients (30.5%) underwent surgery more than five days after symptom onset.
• No significant differences in operative duration, hospital stay, reoperation, conversion rates, or mortality were observed.
• Complications (Clavien-Dindo > 1) were significantly higher in the delayed surgery group (28.2% vs. 10.1%, p=0.009).
• Multivariate analysis identified long symptom duration and older age as risk factors for complications.

Conclusions:

• Extended symptom duration prior to cholecystectomy is associated with an increased risk of post-operative complications.
• Findings suggest a need for careful patient selection and monitoring in delayed surgical cases.
• Further multicenter research is required to validate these results and inform clinical guidelines.