The impact of patient delay and physician delay on the outcome of laparoscopic cholecystectomy for acute cholecystitis

As a serious complication of cholelithiasis, gangrenous cholecystitis presents greater mortality than noncomplicated cholecystitis. The aim of this study was to specify the risk factors on mortality. 107 consecutive patients who underwent surgery due to gangrenous cholecystitis between January 1997 and October 2011 were investigated retrospectively. The study included 60 (56.1%) females and 47 (43.9%) males, with a mean age of 60.7 6 16.4 (21-88) years. Cardiovascular diseases were the most frequently accompanying medical issues (24.3%). Thirty-six complications (33.6%) developed in 29 patients, and surgical site infection was proven as the most common. Longer delay time prior to hospital admission, low white blood cell count, presence of diabetes mellitus, higher blood levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin, pericholecystic fluid in abdominal ultrasonography, and conversion from laparoscopic surgery to open surgery were identified as risk factors affecting mortality (P , 0.001, P ¼ 0.001, P ¼ 0.044, P ¼ 0.005, P ¼ 0.049, P ¼ 0.009, P ¼ 0.022, P ¼ 0.011, and P ¼ 0.004, respectively). Longer delay time prior to hospital admission and low white blood cell count were determined as independent risk factors affecting mortality.

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“…7,16,17 Although 73.8% of the cases in our study were aged 51 years and older, age did not influence mortality.…”

Section: Discussioncontrasting

confidence: 52%

“…Eldar et al 17 reported worsening macroscopic alterations in the case of hospital admissions later than 48 hours. While the total mean time delay to hospital admission of our patients was 21 hours, it was 54 hours in those in whom mortality occurred.…”

Section: Discussionmentioning

confidence: 98%

Gangrenous Cholecystitis: Mortality and Risk Factors

Önder

Kapan

Ülger

et al. 2015

International Surgery

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“…[1][2][3][4]8 The complication rates in the PTGBD group and non-PTGBD groups in this study were 14.0% and 6.8%, respectively. The rate of conversion to open surgery in the studies of Texeira et al, 8 Eldar et al, 3 Lai et al, 2 and Suter and Meyer 4 were relatively high (24%, 28.5%, 22%, and 15.6%, respectively). In the present study, the conversion rate was 8.8% in the PTGBD group and 9.1% in the non-PTGBD group, a difference that was not significant (p=0.956).…”

Section: Discussionmentioning

confidence: 92%

“…[1][2][3][4] The safety 3,5,6 and the optimal timing of laparoscopic cholecystectomy [1][2][3]7 have been studied; generally, the outcomes have been good when laparoscopic cholecystectomy is carried out early. [1][2][3][4][5] In addition, several studies have evaluated laparoscopic cholecystectomy after selective sustained percutaneous transhepatic gallbladder drainage (PTGBD) for the control of severe inflammation 3,[8][9][10] and improvement of cholecystitis-induced disorders. Especially, Chikamori et al 11 reported on 16 laparoscopic cholecystectomy patients with PTGBD who experienced a reduced duration of surgery and a lower rate of conversion to open laparotomy compared with laparoscopic cholecystectomy pa-tients who did not receive PTGBD and also those who underwent delayed laparoscopic cholecystectomy after conservative therapy.…”

Section: Introductionmentioning

confidence: 99%

The Benefits of Percutaneous Transhepatic Gallbladder Drainage prior to Laparoscopic Cholecystectomy for Acute Cholecystitis

Kim

Ahn

et al. 2016

J Minim Invasive Surg

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Purpose: Several studies have reported that laparoscopic cholecystectomy with percutaneous transhepatic gallbladder drainage (PTGBD) is associated with a reduced duration of surgery and a lower rate of conversion to open laparotomy compared with laparoscopic cholecystectomy without PTGBD and delayed laparoscopic cholecystectomy after conservative therapy. However, these results are contradictory. This retrospective study investigated the safety and usefulness of laparoscopic cholecystectomy combined with pre-operative PTGBD in patients with acute cholecystitis. Methods:The clinicopathologic data and surgical outcomes of 101 patients who underwent laparoscopic cholecystectomy between January 2010 and September 2015 were reviewed retrospectively. Results:Patients in the PTGBD group vs. the non-PTGBD group were significantly older (mean age: 65.47±12.2 vs. 56.32±13.7; p=0.001). Underlying diseases were also significantly more common in the PTGBD group (75.4% vs. 45.5%; p=0.002). There were no significant differences between the two groups in terms of operative time, blood loss, rate of open conversion, postoperative oral intake, and postoperative hospital stay. Total hospital day was significantly longer in the PTGBD group (11.14±7.22 vs. 6.23±5.17; p=0.049). There was no significant difference in the postoperative complications between the two groups, and all patients in this study lived. Conclusion:This study suggested that satisfactory results can be achieved with selective preoperative PTGBD in older and sicker patients with acute cholecystitis.

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“…The latter underlines the need for early intervention, initiated within 72 hours after onset of symptoms. [27][28][29][30][31][32] Other proposals to decrease conversion and complication rates include percutaneous trans-hepatic gall bladder drainage followed by elective cholecystectomy 11 and laparoscopic subtotal cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

Empyema of the Gall Bladder: Reappraisal in the Laparoscopy Era

2003

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Background: In evaluations of laparoscopic cholecystectomy for acute cholecystitis, the role of this technique specifically for empyema of the gall bladder has not been separately addressed. Therefore, we describe the demographic characteristics, clinical and laboratory findings, management and outcome of patients presenting with empyema of the gall bladder who were treated with open cholecystectomy or laparoscopic cholecystectomy. Patients and Methods: Our retrospective evaluation included 1449 patients who underwent cholecystectomy over 88 months, including a 30-month period when open cholecysectomy was the standard operation and a 58-month period when laparoscopic cholecysectomy became the standard operation for acute and chronic cholecystitis. Results: Of the 1449 cholecysectomies, 29 cases proved to have empyema, an incidence of 2%. Males constituted 48.3% of the patients (vs. 22% for the whole cholecystectomy group, P≤0.005) and the average age was 54.6 years (vs. 43 years for the whole cholecystectomy group, P≤0.005). The clinical picture was indistinguishable from other forms of acute cholecystitis. Laparoscopic cholecystectomy was attempted for all the patients in the laparoscopy era with a conversion rate of 42%, significantly higher than other forms of gall bladder diseases (P=0.002). Conclusion: Empyema of the gall bladder is more often encountered in males and the elderly. The clinical picture is indistinguishable from other forms of acute cholecystitis and a preoperative diagnosis is difficult. Early laparoscopic cholecystectomy is advisable for all patients with acute cholecystitis. A higher conversion rate is expected for patients with empyema.

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The impact of patient delay and physician delay on the outcome of laparoscopic cholecystectomy for acute cholecystitis

Cited by 69 publications

References 9 publications

Gangrenous Cholecystitis: Mortality and Risk Factors

Gangrenous Cholecystitis: Mortality and Risk Factors

The Benefits of Percutaneous Transhepatic Gallbladder Drainage prior to Laparoscopic Cholecystectomy for Acute Cholecystitis

Empyema of the Gall Bladder: Reappraisal in the Laparoscopy Era

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