Early cholecystectomy (< 72 h) is associated with lower rate of complications and bile duct injury: a study of 109,862 cholecystectomies in the state of New York

Maria S. Altieri, L. Michael Brunt, Jie Yang, Chencan Zhu, Mark A. Talamini, Aurora D. Pryor

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Introduction: The timing of cholecystectomy for acute cholecystitis has been debated with most studies favoring early cholecystectomy (< 72 h of onset). However, most reported studies are from single institution studies with only a few population-based studies. The purpose of this study is to compare clinical outcomes of patients undergoing cholecystectomy within 72 h of emergency department (ED) presentation to patients undergoing cholecystectomy following 72 h in a large statewide database. Methods: The New York SPARCS administrative database was used to identify all adult patients presenting to the ED with a diagnosis of acute cholecystitis from 2005 to 2016. Patients aged < 18, missing data, or other biliary diagnoses were excluded from the analysis. Early cholecystectomy was defined as within 72 h of presentation to the emergency department. Early vs late groups were compared in terms of overall complications, bile duct injury (BDI), hospital length of stay (LOS), 30-days ED visits and readmissions. The linear trends of yearly early/late cholecystectomies were examined using a log-linear Poisson regression models. Multivariable logistic regression model was used to compare complications, BDI, and 30-day readmission/ED visits after controlling for confounding factors. Multivariable generalized linear regression for a negative binomial distributed count data was used to compare LOS. Results: Following the application of the inclusion/exclusion criteria, there were 109,862 patients who presented to an ED with the diagnosis of acute cholecystitis. The majority of patients underwent early cholecystectomy (n = 93,761, 85.3%), whereas only 16,101 patients underwent late cholecystectomy (14.7%). There was an increasing trend of early cholecystectomy from 2005 (81.1%) to 2016 (87.8%). On multivariable regression, patients with early cholecystectomy were less likely to have complications (OR 0.542, 95% CI 0.518–0.566), had shorter LOS (ratio 0.461, 95% CI 0.458–0.465), were less likely to have 30-day readmission (OR 0.871, 95% CI 0.816–0.928), 30-day ED visits (OR 0.909, 95% CI 0.862–0.959), and bile duct injury (OR 0.654, 95% CI 0.444–0.962) compared to late cholecystectomy patients. Conclusion: Early cholecystectomy (< 72 h) is associated with fewer complications, specifically BDI, shorter LOS, and fewer 30-day readmissions and ED visits. For patients presenting to the ED for acute cholecystitis, early cholecystectomy should be preferred.

Original languageEnglish
Pages (from-to)3051-3056
Number of pages6
JournalSurgical endoscopy
Volume34
Issue number7
DOIs
StatePublished - Jul 1 2020

Keywords

  • Cholecystectomy
  • Delayed
  • Early
  • Outcomes

Fingerprint

Dive into the research topics of 'Early cholecystectomy (< 72 h) is associated with lower rate of complications and bile duct injury: a study of 109,862 cholecystectomies in the state of New York'. Together they form a unique fingerprint.

Cite this