Evaluation of Early Cholecystectomy versus Delayed Cholecystectomy in the Treatment of Acute Cholecystitis

Abstract

Objective. To evaluate if early cholecystectomy (EC) is the most appropriate treatment for acute cholecystitis compared to delayed cholecystectomy (DC). Patients and Methods. A retrospective cohort study of 1043 patients was carried out, with a group of 531 EC cases and a group of 512 DC patients. The following parameters were recorded: (1) postoperative hospital morbidity, (2) hospital mortality, (3) days of hospital stay, (4) readmissions, (5) admission to the Intensive Care Unit (ICU), (6) type of surgery, (7) operating time, and (8) reoperations. In addition, we estimated the direct cost savings of implementing an EC program. Results. The overall morbidity of the EC group (29.9%) was significantly lower than the DC group (38.7%). EC demonstrated significantly better results than DC in days of hospital stay (8.9 versus 15.8 days), readmission percentage (6.8% versus 21.9%), and percentage of ICU admission (2.3% versus 7.8%), which can result in reducing the direct costs. The patients who benefited most from an EC were those with a Charlson index > 3. Conclusions. EC is safe in patients with acute cholecystitis and could lead to a reduction in the direct costs of treatment.

The timing of laparoscopic cholecystectomy in acute cholecystitis: importance of first 72 hours and oxidative stress markers

“…These findings are similar to many studies in the literature, but in these studies, it was seen that the patients in the late group operated between 8 days and 12 weeks. [17,18,[21][22][23][24] In one retrospective study, it is shorter in the early cholecystectomy group. [16] A meta-analysis study involving fifteen randomized controlled trials reported that the operative time in the early cholecystectomy group (seven days following symptom onset) was significantly longer.…”

“…The time limit for early LC is defined in some studies as the first 72 hours following symptom onset, [16][17][18] and in other studies, it is describe as the first 1 to 10 days. [19][20][21][22][23] Regardless of the timing of the concept of "early", all of the above-mentioned studies showed that early LC was associated with a reduction in the length of stay, workdays lost, and costs without an increase in conversion or perioperative complications. [16][17][18][19][20][21][22][23] Another important issue in the delayed group (1-8 weeks) is gallstone-related morbidity during the waiting period for a cholecystectomy.…”

“…[19][20][21][22][23] Regardless of the timing of the concept of "early", all of the above-mentioned studies showed that early LC was associated with a reduction in the length of stay, workdays lost, and costs without an increase in conversion or perioperative complications. [16][17][18][19][20][21][22][23] Another important issue in the delayed group (1-8 weeks) is gallstone-related morbidity during the waiting period for a cholecystectomy. [16][17][18]21,23] The most common morbidity is the non-resolution or recurrence of cholecystitis, which occurred in 18.3-29.5%…”

“…[16][17][18][19][20][21][22][23] Another important issue in the delayed group (1-8 weeks) is gallstone-related morbidity during the waiting period for a cholecystectomy. [16][17][18]21,23] The most common morbidity is the non-resolution or recurrence of cholecystitis, which occurred in 18.3-29.5%…”

“…[16,17,24] In contrast, other retrospective studies that had relatively high patient volumes showed high conversion rates (19.7-25.2%), especially in the early LC patient group. [18,21] This could be explained by an experienced surgery team or centers. [24] There was no statistically significant difference in terms of operation time in both groups.…”