title: Optimal time for early laparoscopic cholecystectomy for acute cholecystitis.
abstract: OBJECTIVE
  There is growing evidence in support of performing early laparoscopic cholecystectomy (LC) for acute cholecystitis. However, the definition of early LC varies from 0 through 10 days depending on the research protocol. The optimum time to perform early LC is still unclear.
  
  
  OBJECTIVE
  To determine whether outcomes after early LC for acute cholecystitis vary depending on time from presentation to surgery and to determine the optimum time to perform LC for acute cholecystitis.
  
  
  METHODS
  We performed a retrospective review of prospectively collected data from the Nationwide Inpatient Sample (NIS) for 2005 through 2009. The population-based sample included 95,523 adults (18 years and older) who underwent LC within 10 days of presentation for acute cholecystitis.
  
  
  METHODS
  Patients were categorized and analyzed in 2 ways based on length of time from presentation to surgery. First, patients were categorized into 3 groups: 0 through 1 day, 2 through 5 days, and 6 through 10 days. Second, we compared outcomes for each incremental preoperative day (days 0-5).
  
  
  METHODS
  Outcomes of interest were mortality, length of stay, complications, and cost. Propensity score matching and generalized linear modeling were used. The hypothesis being tested was formulated after data collection was complete.
  
  
  RESULTS
  A total of 95,523 patients were selected. After matching the 3 groups based on propensity scores, patients who underwent surgery during days 2 through 5 and days 6 through 10 had increasingly worse outcomes when compared with those undergoing surgery on days 0 through 1. The odds of mortality were 1.26 (95% CI, 1.00-1.58) and 1.93 (95% CI, 1.38-2.68), and the odds of postoperative infections were 0.88 (95% CI, 0.69-1.12) and 1.53 (95% CI, 1.05-2.23) for days 2 through 5 and days 6 through 10, respectively. Adjusted mean hospital cost increased from $8974 (days 0-1) to $17,745 (days 6-10). Analysis by each incremental day revealed the optimal time of surgery to be within the first 48 hours of presentation.
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy performed within 2 days of presentation of acute cholecystitis yielded the best outcomes and lowest costs. Although causality could not be established, delaying LC was associated with more complications, higher mortality, and higher costs.
authors.affiliation: Department of Surgery, Howard University Hospital, Washington, DC.
authors.forename: Syed Nabeel
authors.initials: SN
authors.lastname: Zafar
authors.affiliation: Department of Surgery, Howard University Hospital, Washington, DC.
authors.forename: Augustine
authors.initials: A
authors.lastname: Obirieze
authors.affiliation: College of Medicine, Howard University, Washington, DC.
authors.forename: Babawande
authors.initials: B
authors.lastname: Adesibikan
authors.affiliation: Department of Surgery, Howard University Hospital, Washington, DC.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.affiliation: Department of Surgery, Howard University Hospital, Washington, DC.
authors.forename: Terrence M
authors.initials: TM
authors.lastname: Fullum
authors.affiliation: Department of Surgery, Howard University Hospital, Washington, DC.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Tran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult