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BACKGROUND: Objective of this study was to examine the effect of delay in cholecystectomy on outcome in patient admitted for acute gallstone disease.
METHODS: Patient with acute gallstone disease admitted inpatient between 2007-2009 were identified from American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using International Classification of disease (ICD-9) diagnosis codes ( 574-574.91) and (575-575.2). Patients were divided into two groups based on days from surgical admission to cholecystectomy within 48 hours (Group 1) and after 48 hours (Group 2). Patient demographic, comorbidities and outcome were compared using t-test and chi-square as appropriate. Regression models were used to adjust for patient and operative risk factors.
RESULT: Patient demographics and preoperative characteristics of patients are detailed in Table 1. Patients who had delayed procedure (>48 hours) have generally higher postoperative complications including pneumonia, unplanned intubation, acute renal failure, MI, DVT, sepsis and bleeding requiring transfusion (Table 2). Delayed procedure was related to higher incidence of re-operation (2.3 vs. 1.7), require prolong postoperative stay (mean 3.6 vs. 2.4 days) and higher cumulative morbidity (). Mortality was significantly higher in delayed surgery group even after adjusting for co-morbidities (A
CONCLUSION: In this retrospective study, delay in surgery was related to higher postoperative complications and mortality in patients with acute gallstone disease. These findings demonstrate that medical optimization of patients should be sought expeditiously to decrease potential post-operative complications.
Table 1. Patient characteristics and co-morbidites

Duration of surgery	Within 48 hours	After 48 hours	P value
Number	19484 (66.9%)	9621 (33.1%)
Age	51.8 ± 18	55.1 ± 19	<0.001
Diabetes on oral hypoglycemic	1614 (8.3%)	958 (10%)	<0.001
Diabetes on Insulin	870 (4.5%)	732 (7.6%)	<0.001
BMI	30 ± 36	29 ±9	0.51
Smoking	3840 (19.7%)	1868 (19.4%)	0.561
Severe COPD	670 (3.4%)	535 (5.6%)	<0.001
CHF	90 (0.5%)	240 (2.5%)	<0.001
History of MI	69 (0.4%)	86 (0.9%)	<0.001
Prior PCI	829 (4.3%)	623 (6.5%)	<0.001
CABG	977 (5.0%)	820 (8.5%)	<0.001
ESRD	163 (0.8%)	211 (2.2%)	<0.001
Hypertension	7599 (39.0%)	4658 (48.4%)	<0.001
Prior peripheral revascularization	189 (1%)	184 (1.9%)	<0.001
Prior operation within 30 days	138 (0.7%)	239 (2.5%)	<0.001
Partially dependent	666 (3.4%)	932 (9.7%)	<0.001
Totally dependent	137 (0.7%)	260 (2.7%)	<0.001
Bleeding disorder	787 (4%)	926 (9.6%)	<0.001
Steroid Use	389 (2%)	331 (3.4%)	<0.001
Open Cholecystectomy	3931 (20.2%)	2012 (20.9%)	0.146

Table 2. 30-day Moratliy and postoperative complications

	Within 48 hours N= 19484	After 48 hours N= 9621	P value
Superficial SSI	353 (1.8%)	142 (1.5%)	0.039
Deep SSI	53 (0.3%)	24 (0.2%)	0.804
Organ space SSI	179 (0.9%)	94 (1%)	0.653
Wound Dehiscence	50 (0.3%)	34 (0.4%)	0.162
Pneumonia	192 (1%)	143 (1.5%)	<0.001
Unplanned Intubation	174 (0.9%)	144 (1.5%)	<0.001
Pulmonary Embolism	31 (0.15%)	31 (0.3%)	0.006
Failure to wean > 24hours	140 (0.7%)	150 (1.6%)	<0.001
Acute renal failure	40 (0.2%)	45 (0.5%)	<0.001
UTI	173 (0.9%)	141 (1.5%)	<0.001
MI	38 (0.2%)	25 (0.3%)	0.284
Bleeding required transfusion	24 (0.1%)	36 (0.4%)	<0.001
DVT	31 (0.2%)	51 (0.5%)	<0.001
Sepsis	207 (1.1%)	168 (1.7%)	<0.001
Return to OR	337 (1.7%)	220 (2.3%)	0.001
Operative time	86.3 ±48	88.6 ± 48	<0.001
Days from operation to discharge	2.4 ± 3.7	3.6 ± 5.4	<0.001
Cumulative morbidity	832 (4.3%)	696 (7.2%)	<0.001
Mortality	83 (0.4%)	151 (0.6%)	<0.001