title: Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304).
abstract: OBJECTIVE
  Acute cholecystitis is a common disease, and laparoscopic surgery is the standard of care.
  
  
  BACKGROUND
  Optimal timing of surgery for acute cholecystitis remains controversial: either early surgery shortly after hospital admission or delayed elective surgery after a conservative treatment with antibiotics.
  
  
  METHODS
  The ACDC ("Acute Cholecystitis-early laparoscopic surgery versus antibiotic therapy and Delayed elective Cholecystectomy") study is a randomized, prospective, open-label, parallel group trial. Patients were randomly assigned to receive immediate surgery within 24 hours of hospital admission (group ILC) or initial antibiotic treatment, followed by delayed laparoscopic cholecystectomy at days 7 to 45 (group DLC). For infection, all patients were treated with moxifloxacin for at least 48 hours. Primary endpoint was occurrence of predefined relevant morbidity within 75 days. Secondary endpoints were as follows: (1) 75-day morbidity using a scoring system; (2) conversion rate; (3) change of antibiotic therapy; (4) mortality; (5) costs; and (6) length of hospital stay.
  
  
  RESULTS
  Morbidity rate was significantly lower in group ILC (304 patients) than in group DLC (314 patients): 11.8% versus 34.4%. Conversion rate to open surgery and mortality did not differ significantly between groups. Mean length of hospital stay (5.4 days vs 10.0 days; P < 0.001) and total hospital costs (€2919 vs €4262; P < 0.001) were significantly lower in group ILC.
  
  
  CONCLUSIONS
  In this large, randomized trial, laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs. Therefore, we believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients. (NCT00447304).
authors.affiliation: Departments of *Surgery and †Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany ‡Department of Surgery, Katharinen Hospital, Stuttgart, Germany; §Department of Surgery, St. Marien Hospital Muelheim, Muelheim ¶Department of Surgery, Bietigheim Hospital, Bietigheim-Bissingen, Germany ‖Department of Surgery, Ketteler Hospital, Offenbach, Germany; Departments of **Surgery I and ††Internal Medicine II, Diakonie Hospital, Schwaebisch Hall, Germany ‡‡Department of Surgery, Rostock University Hospital, Germany §§Department of Internal Medicine, Katharinen Hospital, Stuttgart, Germany; Departments of ¶¶Surgery and ‖‖Gastroenterology, Magdeburg Hospital, Magdeburg, Germany ***Department of Surgery, Bad Cannstatt Hospital, Stuttgart, Germany †††Karlsruhe Hospital, Karlsruhe, Germany; Department of ‡‡‡Internal Medicine, Salem Hospital, Heidelberg, Germany §§§Research and Public Relations, Burscheid, Germany ¶¶¶Department of Surgery, Salem Hospital, Heidelberg, Germany.
authors.forename: Carsten N
authors.initials: CN
authors.lastname: Gutt
authors.forename: Jens
authors.initials: J
authors.lastname: Encke
authors.forename: Jörg
authors.initials: J
authors.lastname: Köninger
authors.forename: Julian-Camill
authors.initials: JC
authors.lastname: Harnoss
authors.forename: Kilian
authors.initials: K
authors.lastname: Weigand
authors.forename: Karl
authors.initials: K
authors.lastname: Kipfmüller
authors.forename: Oliver
authors.initials: O
authors.lastname: Schunter
authors.forename: Thorsten
authors.initials: T
authors.lastname: Götze
authors.forename: Markus T
authors.initials: MT
authors.lastname: Golling
authors.forename: Markus
authors.initials: M
authors.lastname: Menges
authors.forename: Ernst
authors.initials: E
authors.lastname: Klar
authors.forename: Katharina
authors.initials: K
authors.lastname: Feilhauer
authors.forename: Wolfram G
authors.initials: WG
authors.lastname: Zoller
authors.forename: Karsten
authors.initials: K
authors.lastname: Ridwelski
authors.forename: Sven
authors.initials: S
authors.lastname: Ackmann
authors.forename: Alexandra
authors.initials: A
authors.lastname: Baron
authors.forename: Michael R
authors.initials: MR
authors.lastname: Schön
authors.forename: Helmut K
authors.initials: HK
authors.lastname: Seitz
authors.forename: Dietmar
authors.initials: D
authors.lastname: Daniel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stremmel
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D001372:Aza Compounds / Q000191:economics / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000379:methods*; D041881:Cholecystitis, Acute / Q000188:drug therapy / Q000191:economics / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D005260:Female; D024841:Fluoroquinolones; D005858:Germany; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D057194:Intention to Treat Analysis; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011804:Quinolines / Q000191:economics / Q000627:therapeutic use; D017524:Slovenia; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D000077266:Moxifloxacin