Early cholecystectomy (<72 hours) is associated with lower rate of complications and bile duct injury: a study of 109,862 cholecystectomies in the state of New York

Maria S Altieri, MD, MS¹, L. Michael Brunt, MD¹, Jie Yang, PhD², Chencan Zhu, MS², Mark Talamini, MD, MBA², Aurora Pryor, MD². ¹Washington University School of Medicine, ²Stony Brook University Hospital

Introduction: Cholecystectomy is the standard of care for patients with acute cholecystitis.  Timing of cholecystectomy has been debated, as recently early cholecystectomy (<72 hours) has been the preferred choice.  However, data favoring early cholecystectomy includes single institution studies.  The purpose of this study is to compare clinical outcomes of  patients undergoing cholecystectomy within 72 hours of ED presentation to patients undergoing cholecystectomy following 72 hours. 

Methods: The New York SPARCS administrative database was used to identify all adult patients presenting to the ED with diagnosis of acute cholecystitis.  Patients age < 18, missing data, or other biliary diagnosis were excluded from the analysis.  Early cholecystectomy was identified as within 72 hours of presentation to the emergency department.  Early vs late groups were compared in terms of overall complications, bile duct injury (BD), hospital length of stay (LOS), 30-days ED visits and readmissions.  The linear trends of yearly early/late cholecystectomies were examined using a log-linear Poisson regression models.  Multivariable logistic regression model was used to compare complication, BD, 30-day readmission/ED visit after controlling for confounding factors. Multivariable generalized linear regression for a negative binomial distributed count data was used to compare LOS.   

Results: Following the application of the inclusion/exclusion criteria, there were 109, 862 patients who presented to the ED with the diagnosis of acute cholecystitis.  The majority of the patients underwent an early cholecystectomy (n=93,761, 85.3% ), whereas only 16,101 patients underwent late cholecystectomy (14.7%).  There was an increasing trend of early cholecystectomy from 2005 (81.08%) to 2016 (87.8%) (Figure 1).  Following multivariable logistic regression, patients with early cholecystectomy were less likely to have complications (OR=0.542, 95% CI: 0.518-0.566), had shorter LOS (ratio=0.461, 95% CI: 0.458-0.465), were less likely to have 30-day readmission (OR=0.871, 95% CI: 0.816-0.928), 30-day ED visits (OR=0.909, 95% CI: 0.862-0.959), and CBD injury (OR=0.654, 95% CI: 0.444-0.962) compared to late cholecystectomy patients.

Conclusion: Early cholecystectomy (<72 hours) has been associated with fewer complications, specifically BDI.  In addition, patients undergoing early cholecystectomy have lower LOS, 30-day readmissions and ED visits.  For patients presenting to the ED for acute cholecystitis, early cholecystectomy should be preferred. 

 

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Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94531

Program Number: S004

Presentation Session: Biliary

Presentation Type: Podium