Delaying Cholecystectomy Tied to More Complications

By Megan Brooks

November 07, 2019

NEW YORK (Reuters Health) - Waiting more than 72 hours for cholecystectomy in patients with acute cholecystitis is associated with more complications and longer time spent in the hospital, according to new research.

"This study suggests that early cholecystectomy after admission seems warranted and that patients admitted on a Friday should not wait until Monday to undergo the operation," lead author Dr. Michael Scott and colleagues from Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, write in an abstract presented October 30 at the American College of Surgeons (ACS) Clinical Congress in San Francisco.

Using the 2012-2016 ACS National Surgical Quality Improvement Program database, the researchers identified patients who underwent laparoscopic or open abdominal surgery for acute cholecystitis. They divided them into three groups: a reference group of 12,968 patients who had their gallbladders removed within 24 hours of admission; a group of 26,758 patients who had surgery between 24 and 72 hours after admission; and 9,594 patients whose operation was delayed 72 hours or more after admission.

"Delays happen frequently," Dr. Scott told Reuters Health by email, and until now it has not been clear what effect these delays have.

After adjusting for confounding factors such as age, BMI and diabetes, patients who had cholecystectomy more than 72 hours after admission had significantly longer hospital stay (about five days versus two days with surgery within 24-72 hours and one day with surgery in under 24 hours).

The group waiting more than 72 hours were also more apt to have an open rather than laparoscopic procedure (odds ratio, 1.28; P<0.01).

Delaying surgery three days or more was associated with a significantly higher risk of complications, including venous thromboembolism (OR, 1.83) and postoperative sepsis (OR, 1.53). The 30-day readmission rate was also significantly higher when surgery was delayed more than 72 hours (OR, 1.25).

Going forward, the researchers say it will be important to pinpoint the reasons for the delay in performing cholecystectomy. Dr. Scott told Reuters Health in his experience as a surgical resident, there are any number of reasons why a patient might be delayed to surgery.

"The reasons can be patient-specific, such as a sicker patient with more comorbidities who may need medical optimization before undergoing surgery. They can be hospital-specific, such as limited availability to an appropriately staffed and stocked operating room, especially during off-hours. They can be surgeon-specific, such as having a busy clinical or operative schedule," said Dr. Scott.

SOURCE: http://bit.ly/2JQ0FSo

American College of Surgeons 2019 Clinical Congress.

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