title: Acute cholecystitis: the golden 72-h period is not a strict limit to perform early cholecystectomy. Results from 316 consecutive patients.
abstract: OBJECTIVE
  Early laparoscopic cholecystectomy (ELC) is the treatment of choice for acute cholecystitis (AC), but the optimal surgical timing is controversial. The aim of this study was to retrospectively verify the outcome of patients with AC according to different timing of cholecystectomy.
  
  
  METHODS
  Patients undergoing cholecystectomy for AC from 2006 to 2012 were stratified into two groups: initial admission cholecystectomy (IAC) and delayed cholecystectomy (DC, after at least 4 weeks). Among IAC, a subgroup undergoing immediate cholecystectomy (IC, within 72 h of symptom onset) was further analyzed.
  
  
  RESULTS
  Three-hundred and sixteen consecutive patients were studied. IAC group included 262 patients (82.9 %) and DC group included 54 patients (17.1 %). The two groups were similar in conversion rate, operation length, and overall complication rate. The total length of hospitalization was longer in DC patients (p = 0.005). Among DC patients, 25.9 % required re-hospitalization while waiting an elective procedure. In the group undergoing IC (66 patients), conversion rate, length of operation, and postoperative morbidity were similar to that of the IAC group. Length of stay was shorter in IC group (p < 0.001). Multivariate analysis identified moderate-severe AC grading and ASA score ≥ 3 as predictors of postoperative complications.
  
  
  CONCLUSIONS
  The timing of cholecystectomy for AC does not seem to affect conversion rate and postoperative morbidity. Therefore the 72-h period should not be considered a strict limit to perform LC, provided that the operation is carried out during the initial hospital admission.
authors.affiliation: Department of Surgery, University of Milano-Bicocca, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy, degluc@inwind.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Degrate
authors.forename: Arianna Libera
authors.initials: AL
authors.lastname: Ciravegna
authors.forename: Margherita
authors.initials: M
authors.lastname: Luperto
authors.forename: Marcello
authors.initials: M
authors.lastname: Guaglio
authors.forename: Mattia
authors.initials: M
authors.lastname: Garancini
authors.forename: Matteo
authors.initials: M
authors.lastname: Maternini
authors.forename: Laura
authors.initials: L
authors.lastname: Giordano
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Romano
authors.forename: Luca
authors.initials: L
authors.lastname: Gianotti
authors.forename: Franco
authors.initials: F
authors.lastname: Uggeri
mesh_terms: D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome