title: Early versus delayed surgery for acute cholecystitis as an applied treatment strategy when assessed in a population-based cohort.
abstract: BACKGROUND
  The aims of this study were to describe the surgical management of acute cholecystitis (AC) in a well-defined population-based patient cohort, in particular adherence to and outcome of the early open/laparoscopic cholecystectomy (EC/ELC) strategy.
  
  
  METHODS
  The medical records of all patients residing in Stockholm County who were treated for AC during 2003 and 2008 were reviewed according to a standardized protocol.
  
  
  RESULTS
  In 2003, 799 patients were admitted 850 times for AC, and the respective figures for 2008 were 833 and 919. The number of patients who underwent EC/ELC increased from 42.9% in 2003 to 47.4% in 2008. In multivariate regression analysis adjusting for age, gender, severity of cholecystitis, maximal CRP and maximal WBC, EC/ELC was associated with shorter operation time but higher perioperative blood loss when compared to delayed open/laparoscopic cholecystectomy (DC/DLC). The odds ratio for completing the procedure laparoscopically was significantly higher in DC/DLC when adjusting for the same covariates. There were no significant differences in peri- or postoperative complications between the groups.
  
  
  CONCLUSIONS
  Strategies should be implemented in order to secure a more evidence-based approach to the surgical treatment of AC.
authors.affiliation: Department of Surgery, Söder Hospital, Stockholm, Sweden.
authors.forename: Emil
authors.initials: E
authors.lastname: Pieniowski
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Popowicz
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.forename: Peter
authors.initials: P
authors.lastname: Gerber
authors.forename: Ulf
authors.initials: U
authors.lastname: Gustafsson
authors.forename: Helen
authors.initials: H
authors.lastname: Sinabulya
authors.forename: Krister
authors.initials: K
authors.lastname: Sjödahl
authors.forename: Andrianos
authors.initials: A
authors.lastname: Tsekrekos
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandblom
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index; D013548:Sweden; D061665:Time-to-Treatment; D016896:Treatment Outcome