Acute Cholecystitis-Optimal Timing for Early Cholecystectomy: a French Nationwide Study.
BACKGROUND
The recommended treatment for acute calculous cholecystitis combines antibiotics and cholecystectomy. To reduce morbidity and mortality, guidelines recommend early cholecystectomy. However, the optimal timing for surgery on first admission remains controversial. This study aims to determine the best timing for cholecystectomy in patients presenting with acute calculous cholecystitis.


METHODS
The French national health-care database was analyzed to identify all patients undergoing cholecystectomy for acute cholecystitis during the same hospital stay between January 2010 and December 2013. Data regarding patients, procedures, and hospitals characteristics were collected. The relationship between surgery's timing and clinical outcome was evaluated by multiple logistic regressions.


RESULTS
Overall, 42,452 patients from 507 hospitals were included in the study. Postoperative complications requiring invasive treatment occurred in 961 patients (2.3 %), and the mortality rate was 1.1 %. Adverse postoperative outcomes-intensive care admission, reoperation, and postoperative sepsis-were significantly lower when surgery was performed between days 1 and 3 (3-3.3, 0.5-0.6, and 3.8-4.1 %, respectively) when compared to surgery performed on the day of admission (5.6, 1.2, and 5.2 %, p < 0.001) or from day 5 onward (4.5, 1, and 6.5 %, respectively; p < 0.001). Mortality was also significantly lower in patients undergoing cholecystectomy between days 1 and 3 after admission (0.8-1 %) when compared to patients operated on the day of admission or after day 3 (1.4 % on day 0, 1.2 % on day 4, and 1.9 % from day 5: all p < 0.001).


CONCLUSIONS
For patients with acute calculous cholecystitis, all efforts should be made to perform cholecystectomy within 3 days after hospital admission in order to decrease morbidity and mortality.
Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France.
Maxime
M
Polo
Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France.|EMR 3738 Université Lyon 1, F-69364, Lyon, France.|Center for Surgery and Public Health, Brigham and Women's Hospital-Harvard Medical School, Boston, MA, USA.
Antoine
A
Duclos
Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France.
Stéphanie
S
Polazzi
Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France.
Cécile
C
Payet
Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France.|Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France.|EMR 3738 Université Lyon 1, F-69364, Lyon, France.
Jean Christophe
JC
Lifante
Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France.|Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France.|EMR 3738 Université Lyon 1, F-69364, Lyon, France.
Eddy
E
Cotte
Department of General Surgery, Hospices Civils de Lyon, Hop Ed. Herriot, 69003, Lyon, France.
Xavier
X
Barth
Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France.|Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France.|EMR 3738 Université Lyon 1, F-69364, Lyon, France.
Olivier
O
Glehen
Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France. guillaume.passot@chu-lyon.fr.|Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France. guillaume.passot@chu-lyon.fr.|EMR 3738 Université Lyon 1, F-69364, Lyon, France. guillaume.passot@chu-lyon.fr.
Guillaume
G
Passot
D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000601:surgery*; D005260:Female; D005602:France; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061665:Time-to-Treatment; D016896:Treatment Outcome
Acute cholecystitis; Outcome; Surgical timing