title: The Sooner, the Better? The Importance of Optimal Timing of Cholecystectomy in Acute Cholecystitis: Data from the National Swedish Registry for Gallstone Surgery, GallRiks.
abstract: Up-front cholecystectomy is the recommended therapy for acute cholecystitis (AC). However, the scientific basis for the definition of the optimal timing for surgery is scarce. The aim of this study was to analyze how the timing of surgery, after the admission to hospital for AC, affects the intra- and postoperative outcomes. Within the national Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks), all patients undergoing cholecystectomy for acute cholecystitis between January 2006 and December 2014 were identified. Data regarding patient characteristics, intra- and postoperative adverse events (AEs), bile duct injuries, and 30- and 90-day mortality risk were captured, and the correlation between the surgical timing and these parameters was analyzed. In total, data on 87,108 cholecystectomies were analyzed of which 15,760 (18.1 %) were performed due to AC. Bile duct injury, 30- and 90-day mortality risk, and intra- and postoperative AEs were significantly higher if the time from admission to surgery exceeded 4 days. The time course between surgery and complication risks seemed to be optimal if surgery was done within 2 days after hospital admission. Although AC patients operated on the day of hospital admission had a slightly increased AE rate as well as 30- and 90-day mortality rates than those operated during the interval of 1-2 days after admission, the bile duct injury and conversion rates were, in fact, significantly lower. The optimal timing of cholecystectomy for patients with AC seems to be within 2 days after admission. However, the somewhat higher frequency of AE on admission day may emphasize the importance of optimizing the patient before surgery as well as ensuring that adequate surgical resources are available.
authors.affiliation: Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. my.blohm@ltdalarna.se.|Department of Surgery, Mora Hospital, 792 85, Mora, Sweden. my.blohm@ltdalarna.se.
authors.forename: My
authors.initials: M
authors.lastname: Blohm
authors.affiliation: Department of Surgery, Mora Hospital, 792 85, Mora, Sweden.
authors.forename: Johanna
authors.initials: J
authors.lastname: Österberg
authors.affiliation: Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.|Center for Digestive Diseases, Karolinska University Hospital, 141 86, Stockholm, Sweden.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandblom
authors.affiliation: Center for Digestive Diseases, Karolinska University Hospital, 141 86, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.affiliation: Department of Surgery, Mora Hospital, 792 85, Mora, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Hedberg
authors.affiliation: Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. lars.enochsson@ki.se.|Center for Digestive Diseases, Karolinska University Hospital, 141 86, Stockholm, Sweden. lars.enochsson@ki.se.
authors.forename: Lars
authors.identifier: 0000-0002-1930-654X
authors.initials: L
authors.lastname: Enochsson
mesh_terms: D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000453:epidemiology / Q000209:etiology; D001652:Bile Ducts / Q000293:injuries; D016022:Case-Control Studies; D002763:Cholecystectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000706:statistics & numerical data; D041881:Cholecystitis, Acute / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
keywords: Acute cholecystitis; Admission day; Adverse events; Bile duct injury; Laparoscopic cholecystectomy; Open cholecystectomy