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Background: Historically, uncomplicated gallbladder disease has been treated electively. The introduction of laparoscopic cholecystectomy (LC) and its increasing availability have changed how patients with gallbladder disease are managed and treated. Our purpose is to evaluate national practice trends with (LC) for gallbladder disease.Methods: Using the Nationwide Inpatient Sample data base, we extracted and analyzed data for LC between 1997 and 2006 using procedure specific codes. Cholecystectomy performed as part of another primary procedure was excluded. We calculated annual national volumes for LC, the associated in-hospital mortality rates, conversion and bile duct injury rates and length of stay (LOS) following the procedure. We then analyzed selected patient and institutional characteristics to determine if a significant association existed between these factors and the selected postoperative outcomes of interest.Results: Between 1997 and 2006 there were a total of 3,504,249 LC’s performed. While there was little change in diagnosis, there was a 16.2% (p=<0.001) increase in emergent admissions and there was an 18.4% (p= <0.001) increase in patients admitted through the ER over the study period. The proportion of patients with acute cholecystitis (94.3%) remained similar over the study period. Conversely, routine admissions decreased by 15.5% (p=<0.001) during the same period. A 9%(p=<0.001) increase in admission to teaching hospitals was also observed. Despite these findings, average inpatient mortality (0.5 %), conversion rate (8.4 %), bile duct injury rate (0.3%) and LOS (3 days) remained relatively unchanged. CONCLUSIONS: Over a 10 year period, national data has shown a trend towards emergent LC despite similar rates in the diagnosis of cholecystits. This may indicate that either uninsured patients need to be admitted from the ER in order to have an operation and/ or surgeons prefer to admit and operate on patients with cholecysitis during the acute period of the disease.