Early versus Delayed Surgery for Acute Cholecystitis as an Applied Treatment Strategy When Assessed in a Population-Based Cohort

Abstract

Background: The aims of this study were to describe the surgical management of acute cholecystitis (AC) in a well-defined population-based patient cohort, in particular adherence to and outcome of the early open/laparoscopic cholecystectomy (EC/ELC) strategy. Methods: The medical records of all patients residing in Stockholm County who were treated for AC during 2003 and 2008 were reviewed according to a standardized protocol. Results: In 2003, 799 patients were admitted 850 times for AC, and the respective figures for 2008 were 833 and 919. The number of patients who underwent EC/ELC increased from 42.9% in 2003 to 47.4% in 2008. In multivariate regression analysis adjusting for age, gender, severity of cholecystitis, maximal CRP and maximal WBC, EC/ELC was associated with shorter operation time but higher perioperative blood loss when compared to delayed open/laparoscopic cholecystectomy (DC/DLC). The odds ratio for completing the procedure laparoscopically was significantly higher in DC/DLC when adjusting for the same covariates. There were no significant differences in peri- or postoperative complications between the groups. Conclusion: Strategies should be implemented in order to secure a more evidence-based approach to the surgical treatment of AC.

Early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case–control studies

“…However, the implementation of this evidence-based practice is a real obstacle for many hospitals. A recent study in Sweden showed no major changes in the management of acute cholecystitis between 2003 and 2008 despite evidence favouring early surgery [104]. One reason for failing to implement early LC for acute cholecystitis is the lack of access to emergency operating theatre time and a culture that acute cholecystitis is not a surgical emergency.…”

Admission CRP Level as an Indicator for the Need of Percutaneous Cholecystostomy in Acute Cholecystitis

“…Patients with moderate cholecystitis (defined by severe local inflammation), or patients with increased operative risk due to significant comorbidities (even with mild local disease), are treated by I.V antibiotics (further referred as conservative treatment). Moreover, technical and organizational difficulties hamper the implementation of early cholecystectomy even in surgically fit patients [6][7][8][9]. Thus, many patients are not operated at the same admission, but are treated conservatively.…”

Systematic review of antibiotic treatment for acute calculous cholecystitis

“…A total of 89 full‐text articles were assessed for eligibility, and 26 articles were included in the study. Details of relevant excluded studies are shown in Table S1 (supporting information). Of the 26 included articles, 24 were eventually used in the meta‐analysis, because four described the same two studies.…”