title: Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy.
abstract: OBJECTIVE
  To compare clinical outcomes after laparoscopic cholecystectomy (LC) for acute cholecystitis performed at various time-points after hospital admission.
  
  
  BACKGROUND
  Symptomatic gallstones represent an important public health problem with LC the treatment of choice. LC is increasingly offered for acute cholecystitis, however, the optimal time-point for LC in this setting remains a matter of debate.
  
  
  METHODS
  Analysis was based on the prospective database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery and included patients undergoing emergency LC for acute cholecystitis between 1995 and 2006, grouped according to the time-points of LC since hospital admission (admission day (d0), d1, d2, d3, d4/5, d ≥6). Linear and generalized linear regression models assessed the effect of timing of LC on intra- or postoperative complications, conversion and reoperation rates and length of postoperative hospital stay.
  
  
  RESULTS
  Of 4113 patients, 52.8% were female, median age was 59.8 years. Delaying LC resulted in significantly higher conversion rates (from 11.9% at d0 to 27.9% at d ≥6 days after admission, P < 0.001), surgical postoperative complications (5.7% to 13%, P < 0.001) and re-operation rates (0.9% to 3%, P = 0.007), with a significantly longer postoperative hospital stay (P < 0.001).
  
  
  CONCLUSIONS
  Delaying LC for acute cholecystitis has no advantages, resulting in significantly increased conversion/re-operation rate, postoperative complications and longer postoperative hospital stay. This investigation-one of the largest in the literature-provides compelling evidence that acute cholecystitis merits surgery within 48 hours of hospital admission if impact on the patient and health care system is to be minimized.
authors.affiliation: Department of Visceral Surgery and Medicine, Inselspital, University Hospital Berne and University of Berne, CH-3010 Berne, Switzerland.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Banz
authors.forename: Thomas
authors.initials: T
authors.lastname: Gsponer
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
authors.forename: Ulrich
authors.initials: U
authors.lastname: Güller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D004630:Emergencies; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult