title: Can it wait until morning? A comparison of nighttime versus daytime cholecystectomy for acute cholecystitis.
abstract: BACKGROUND
  The urgency of laparoscopic cholecystectomy for acute cholecystitis is under debate. We hypothesized that nighttime cholecystectomy is associated with decreased length of stay.
  
  
  METHODS
  Retrospective review of 1,140 patients at 2 large urban referral centers with acute cholecystitis who underwent daytime (7 am to 7 pm) versus nighttime (7 pm to 7 am) cholecystectomy was conducted.
  
  
  RESULTS
  Nighttime cholecystectomy did not affect the overall length of stay (3.7 vs 3.8 days, P = .08) or complication rate (5% vs 7%, P = .5) versus daytime cholecystectomy. Nighttime cholecystectomy was associated with a higher conversion rate to open cholecystectomy (11% vs 6%, P = .008). On multivariable analysis, independent predictors of conversion to open surgery were nighttime cholecystectomy, age, and gangrenous cholecystitis (P = .01). The only predictor of complications was gangrenous cholecystitis (P = .02).
  
  
  CONCLUSIONS
  Nighttime cholecystectomy is associated with an increased conversion to open surgery without decrease in length of stay or complications. These findings suggest that laparoscopic cholecystectomy for acute cholecystitis should be delayed until normal working hours.
authors.affiliation: Department of Surgery, Olive View - UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: James X
authors.initials: JX
authors.lastname: Wu
authors.affiliation: Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, Olive View - UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: de Virgilio
authors.affiliation: Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Plurad
authors.affiliation: Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA.
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kaji
authors.affiliation: Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA.
authors.forename: Virginia
authors.initials: V
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Gifford
authors.affiliation: Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: de Virgilio
authors.affiliation: Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA.
authors.forename: Reed
authors.initials: R
authors.lastname: Ayabe
authors.affiliation: Department of Surgery, Olive View - UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Darin
authors.initials: D
authors.lastname: Saltzman
authors.affiliation: Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA. Electronic address: dekim@dhs.lacounty.gov.
authors.forename: Dennis
authors.initials: D
authors.lastname: Kim
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D015897:Comorbidity; D061887:Conversion to Open Surgery; D004630:Emergencies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Acute cholecystitis; Laparoscopic cholecystectomy; Nighttime