Acute cholecystitis: the golden 72-h period is not a strict limit to perform early cholecystectomy. Results from 316 consecutive patients

Degrate, Luca; Ciravegna, Arianna Libera; Luperto, Margherita; Guagliò, Marcello; Garancini, Mattia; Maternini, Matteo; Giordano, Laura; Romano, Fabrizio; Gianotti, Luca; Uggeri, Franco

doi:10.1007/s00423-013-1131-0

Cited by 31 publications

(37 citation statements)

References 29 publications

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“…Indeed, in a meta-analysis recognizing the superiority of early surgery, the time limit is variable from 48 h to seven days [12] and recent evidence has not shown clinical advantage with this strict temporal limit. [24][25][26] One question rises looking at the gap between clinical and economic advantages of index cholecystectomy for AAC and the "reluctance" to apply ELC: why? One reason could be still related to the surgeon fair for an anecdotal belief of higher common bile duct injury and higher conversion rate in the acute setting.…”

Section: Discussionmentioning

confidence: 99%

Single center retrospective analysis of early vs. delayed treatment in acute calcolous cholecystitis: application of a clinical pathway and an economic analysis

Pisano

Ceresoli

Allegri

et al. 2015

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Treatment option and timing for surgery in case of acute calculous cholecystitis (ACC) is still a matter of discussion. Tokyo Guidelines (TG13) offers some rules but they don't reflect entirely the information of Evidence Based Medicine (EBM). This study aimed to draw some consideration from our practice in the application of the guidelines and put forward the clinical, economic and organizational effect of it.

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Section: Discussionmentioning

confidence: 99%

Single center retrospective analysis of early vs. delayed treatment in acute calcolous cholecystitis: application of a clinical pathway and an economic analysis

Pisano

Ceresoli

Allegri

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…In critically ill patients, although percutaneous gallbladder drainage is recommended due to its clinical efficacy and simplicity, the morbidity associated with this procedure is high. At present, controversy regarding this treatment exists, and no evidence indicates its use [40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Improving the outcome of acute cholecystitis: the non-standardized treatment must no longer be employed

González-Muñoz

Angoso

Sayagués

et al. 2014

Langenbecks Arch Surg

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Disclosure:The authors declare no conflict of interest. Number of text pages: 17Tables: 1 Figures: 2 Word count: 2222 AbstractPurpose Therapeutic recommendations of acute cholecystitis are not consistently implemented, which generates greater patient morbidity and higher health care costs.The aim of this article is to evaluate the burden of acute cholecystitis, to detect potentially modifiable variables and to propose a therapeutic strategy that will allow us to improve the quality of care.Methods We carried out a retrospective study of patients who were admitted to the hospital from January 2010 to December 2012 using a univariate analysis of parameters including the admitting department, age, treatment administered and length of stay.Results A total of 967 patients were admitted to the hospital with a diagnosis of acute cholecystitis, 692 (72%) to the Surgery department, 257 (26%) to Internal MedicineDigestive and 18 (2%) to other departments. 498 (51.5%) were operated on: 107 (21%) on an urgent basis, 111 (22%) at an early stage (<96 hours at diagnosis), 152 (30%) at a late stage (>96 hours at diagnosis) and 128 (26%) at a delayed date (other admission).Patients who were admitted into the surgery department were five times more likely to be operated on than patients admitted into other departments (p<0.01). Patients operated on at a late stage had a longer length of stay than early stage surgery patients (p<0.05) and than non operated ones (p<0.05). Patients <74 years old were more frequently operated than older ones (p<0.05). ConclusionsThe non-standardized treatment of acute cholecystitis causes high clinical and surgical variability, long average stay, more re-admissions and high hospital costs.Therefore, patients with a diagnosis of acute cholecystitis should be admitted to the Surgery department, thereby increasing the probability of receiving definite treatment.

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“…14 Although early cholecystectomy for acute cholecystitis is generally accepted, 7 recent research questions conventional wisdom when it comes to the elderly or medically unfit patient. [15][16][17][18] First, percutaneous cholecystostomy may not be lifesaving. 16 Second, delaying cholecystectomy in high-risk patients beyond the day of admission serves only to increase operative difficulty and prolong overall length of stay without reducing 30-day morbidity or mortality.…”

Section: Discussionmentioning

confidence: 99%

Mortality Audit of Octogenarians With Acute Cholecystitis

Wysocki

Allen

Rey-Conde

et al. 2014

CRSLS

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Acute cholecystitis: the golden 72-h period is not a strict limit to perform early cholecystectomy. Results from 316 consecutive patients

Abstract: The timing of cholecystectomy for AC does not seem to affect conversion rate and postoperative morbidity. Therefore the 72-h period should not be considered a strict limit to perform LC, provided that the operation is carried out during the initial hospital admission.

Cited by 31 publications

References 29 publications

Single center retrospective analysis of early vs. delayed treatment in acute calcolous cholecystitis: application of a clinical pathway and an economic analysis

Single center retrospective analysis of early vs. delayed treatment in acute calcolous cholecystitis: application of a clinical pathway and an economic analysis

Improving the outcome of acute cholecystitis: the non-standardized treatment must no longer be employed

Mortality Audit of Octogenarians With Acute Cholecystitis

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