Failure to perform index cholecystectomy during acute cholecystitis results in significant morbidity for patients who present with recurrence

Abstract

Background: Although index cholecystectomy is considered the treatment of choice for acute cholecystitis (AC), many hospital systems struggle to provide such a service. The aim of this study was to analyze the effect of failure to perform index cholecystectomy in patients presenting with acute cholecystitis.Methods: Between June 2010 and December 2015, all patients presenting to one hospital with an initial attack of AC were enrolled into a prospective database. Patient's records were reviewed up until point of delayed cholecystectomy or for a minimum of 24 months after the initial presentation with AC. Recurrent AC was defined as early (<6 weeks from initial discharge) or late (>6 weeks from initial discharge). Results: In total 998 patients presented with AC, 409 (41%) of whom were discharged without index cholecystectomy. Eighty-three (20%) patients presented with AC recurrence (ACR). Compared to the first AC episode, patients were more likely to present with grade III AC and suffer significantly greater morbidity (p < 0.05 for all comparisons). A prior history of biliary disease was associated with ACR (p = 0.002). ACR occurred early in 48 (58%) patients and delayed in 35 (42%) patients.Conclusions: Twenty percent of patients discharged without cholecystectomy after their first attack of ACR will develop recurrence within the first two years. Half of ACR will occur within 6 weeks. Patients who present with ACR are more likely to develop more severe AC and are likely to suffer greater morbidity as compared to their first attack.

Index admission cholecystectomy for acute cholecystitis reduces 30-day readmission rates in pediatric patients

“…Although optimal timing of cholecystectomy from symptom onset is still debated, there is consensus in the adult guidelines that cholecystectomy is recommended on initial hospitalization in patients with acute cholecystitis. [5][6][7]16] Conversely, there are no clear guidelines on the timing of cholecystectomy in pediatric patients with acute cholecystitis, so practices are varied with an observed preferred conservative approach in the pediatric population [10]. Our study shows similar results with the adult population in decreasing length of stay and fewer 30-day readmission rates with pediatric patients who underwent index cholecystectomy for acute cholecystitis.…”

“…with acute cholecystitis has been widely studied and shown to be safe with less morbidity, shorter hospital stays, and lower readmission rates than those who underwent delayed cholecystectomy [5][6][7][8][9]. In contrast, ideal surgical timing and management of the pediatric population has been less studied, which has led to heterogenous management practices [10].…”

Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

“…This suggests that conversion and morbidity may be significantly higher in delayed cholecystectomy groups when those requiring emergency interventions are considered. It has even been suggested that delaying cholecystectomy increases risk of severe variants such as gangrenous cholecystitis (77,78).…”

Lithiasic acute cholecystitis: application of Tokyo Guidelines in severity grading

“…The Tokyo Guidelines leave certain freedom for treatment selection 34 , with our first option being surgical treatment, due to the high rate of relapses in nonoperated patients (around 20% regardless of AC grade) and poorer evolution of AC relapse with regard to the first episode 8,35 . The grade has influenced the results of operated patients: the higher the grade, we have observed more complexity in the surgical procedure, higher need for drains and a higher conversion rate, with longer postoperative stay associated and higher morbidity and mortality, especially in the severe AC group.…”