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The Sooner the Better-the Importance of Optimal Timing of Cholecystectomy in Acute Cholecystitis. Data From the National Swedish Registry for Gallstone Surgery, Gallriks (2006 to 2014)
Lars Enochsson*2,1, My Blohm3, Gabriel Sandblom2,1, Johanna Österberg3
1Department of Surgical Gastroenterology, Division of surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; 2Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; 3Department of Surgery, Mora Lasarett, Mora, Sweden
Background:
Early cholecystectomy is recommended by many as a way to reduce postoperative morbidity in acute cholecystitis. However, until now the scientific evidence for such a policy has been scarce. The aim of this study was to analyze how the timing of surgery after admission affects the postoperative outcome.
Methods:
The national Swedish Registry for Gallstone Surgery, ”GallRiks”, was analyzed to identify all patients undergoing cholecystectomy for acute cholecystitis between January 2006 and December 2014. Data regarding patient characteristics, intra- and postoperative adverse events, bile duct injuries and 90 day mortality were registered. The correlation between the timing of surgery and these parameters were analyzed.
Results:
Overall, 89,397 cholecystectomies during the study period were analyzed of which 16,326 (18.3%) were performed due to acute cholecystitis. Bile duct injury, 90 day mortality, intra-and postoperative adverse event rates were significantly higher if the time between admission and surgery exceeded four days. The optimal timing for surgery of acute cholecystitis seems to be between days 1-2 after admission in our study (Image 1). If patients with acute cholecystitis were operated on the same day that they were admitted the absolute adverse event rates as well as 90 day mortality tended to be somewhat higher compared to if they were operated in the time interval 1-2 days after admission.
Conclusion:
The optimal timing of cholecystectomy for patients with acute cholecystitis seems to be within two days after admission. However, the somewhat higher frequencies of adverse event rates on admission-day emphasizes the importance of optimizing the patient before surgery as well as ensuring that adequate surgical resources are available.
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