title: No need to wait: an analysis of the timing of cholecystectomy during admission for acute cholecystitis using the American College of Surgeons National Surgical Quality Improvement Program database.
abstract: BACKGROUND
  The objective of our analysis was to determine the optimal timing of cholecystectomy during admission for acute cholecystitis.
  
  
  METHODS
  All patients from the American College of Surgeons National Surgical Quality Improvement Program Participant User Files from 2005 through 2010 who underwent emergency cholecystectomy within 7 days of hospital admission for acute cholecystitis were included for analysis. The association between timing of cholecystectomy and postoperative outcomes was determined using multivariate logistic regression analyses after adjustment for patient demographics, acute and chronic comorbid medical conditions, preoperative sepsis classification, American Society of Anesthesiologists physical status classification, and preoperative liver function tests.
  
  
  RESULTS
  A total of 5,268 patients were included for analysis. The timing of operation was day of admission for 49.7% of these patients, 1 day after admission for 33.4%, 2 days after admission for 9.5%, 3 days after admission for 3.9%, and 4 days to 7 days after admission for 3.6%. Multivariate logistic regression analyses revealed no significant association between timing of operation and 30-day postoperative mortality or overall morbidity. Patients who underwent operation later in the course of admission were more likely to require an open procedure and sustained significantly longer postoperative and overall lengths of hospitalization. Similar findings were demonstrated for a subgroup of patients who exhibited characteristics that placed them at higher risk for surgical intervention.
  
  
  CONCLUSIONS
  Immediate cholecystectomy is preferred for patients who require hospitalization for acute cholecystitis.
  
  
  METHODS
  Economic/decision analysis, level III.
authors.affiliation: Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27701, USA. john.scarborough@dm.duke.edu
authors.forename: Kelli R
authors.initials: KR
authors.lastname: Brooks
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
authors.forename: Steven N
authors.initials: SN
authors.lastname: Vaslef
authors.forename: Mark L
authors.initials: ML
authors.lastname: Shapiro
mesh_terms: D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D058996:Quality Improvement; D012307:Risk Factors; D061665:Time-to-Treatment