Meta-analysis of randomized controlled trials on the safety and effectiveness of early <i>versus</i> delayed laparoscopic cholecystectomy for acute cholecystitis

Gurusamy, Kurinchi Selvan; Samraj, Kumarakrishnan; Gluud, Christian; Wilson, Ed; Davidson, Brian R

doi:10.1002/bjs.7076

Cited by 96 publications

(180 citation statements)

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“…In their recent systematic review of randomized controlled trials, Gurusamy et al report that there was no significant difference between early and delayed cholecystectomy for AC in terms of BDI or conversion to open cholecystectomy, although total hospital stay was shorter by 4 days in the early patient group. Furthermore, 17.5% of the patients who underwent the delayed surgical approach were operated as an emergency because of nonresolving or recurrent cholecystitis [2]. The overall complication rate was shown in a previous study to be statistically higher if the delay before operation was more than 4 days (19.8% versus 13.3%), as was the local complication rate (13.2% versus 6.5%) [4].…”

Section: Discussionmentioning

confidence: 95%

“…In the present survey, there was no difference in complication rate between early and delayed cholecystectomy groups. However, several meta-analyses and controlled trials recommend early operation for AC [2,17,18].…”

Section: Discussionmentioning

confidence: 99%

“…stay, early laparoscopic cholecystectomy (LC) has come to be considered the standard treatment of AC [1][2][3]. Although an open approach remains a valid option in complicated cases (e.g., gangrenous cholecystitis, etc.…”

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confidence: 99%

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Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium

Navez

Ungureanu²,

Michiels³

et al. 2012

Surg Endosc

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Background Laparoscopic cholecystectomy is considered nowadays as the standard management of acute cholecystitis (AC). However, results from multicentric studies in the general surgical community are still lacking. Methods A prospective multicenter survey of surgical management of AC patients was conducted over a 2-year period in Belgium. Operative features and patients' clinical outcome were recorded. The impact of independent predictive factors on the choice of surgical approach, the risk of conversion, and the occurrence of postoperative complications was studied by multivariate logistic regression analysis.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium

Navez

Ungureanu²,

Michiels³

et al. 2012

Surg Endosc

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“…[23][24][25][26][27][28] Condition-specific outcomes were as follows: receipt of cholecystectomy when admitted with acute cholecystitis; receipt of minimally-invasive appendectomy or cholecystectomy when undergoing surgery for acute appendicitis or cholecystitis; and avoidance of amputation when admitted with lower extremity peripheral artery disease. While alternative treatment may be appropriate for individual patients depending on specific presentation, we contend that receipt of optimal care as defined here represents the ideal management if patients present early and are healthy enough to receive it.…”

Section: Data Source and Outcomesmentioning

confidence: 99%

Association of the Affordable Care Act Medicaid Expansion With Access to and Quality of Care for Surgical Conditions

et al. 2018

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IMPORTANCE Lack of insurance coverage has been associated with delays in seeking care, more complicated diseases at the time of diagnosis, and decreased likelihood of receiving optimal surgical care. The Patient Protection and Affordable Care Act's (ACA) Medicaid expansion has increased coverage among millions of low-income Americans, but its effect on care for common surgical conditions remains unknown. OBJECTIVE To evaluate the association of the ACA's Medicaid expansion with access to timely and recommended care for common and serious surgical conditions. DESIGN, SETTING, AND PARTICIPANTS This quasi-experimental, difference-in-differences study used hospital administrative data to compare patient-level outcomes in expansion vs nonexpansion states before (2010-2013) vs after (2014-2015) expansion. A total of 293 529 patients aged 18 to 64 years with appendicitis, cholecystitis, diverticulitis, peripheral artery disease (PAD), or aortic aneurysm admitted to an academic medical center or affiliated hospital in 27 Medicaid expansion states and 15 nonexpansion states from January 1, 2010, through September 31, 2015, were included in the study. Data analysis was performed from November 1, 2016, to March 3, 2017. EXPOSURES State adoption of Medicaid expansion.MAIN OUTCOMES AND MEASURES Presentation with early uncomplicated disease (diverticulitis without abscess, fistula, or sepsis; nonruptured aortic aneurysm at time of repair; and PAD without ulcerations or gangrene) and receipt of optimal management (cholecystectomy for acute cholecystitis, laparoscopic approach for cholecystectomy or appendectomy, and limb salvage for PAD). RESULTSOf the 293 529 study patients (128 392 [43.7%] female and 165 137 [56.3%] male), 225 572 had admissions in Medicaid expansion states and 67 957 had admissions in nonexpansion states. Medicaid expansion was associated with a 7.5-percentage point decreased probability of patients being uninsured (95% CI, −12.2 to −2.9; P = .002) and an 8.6-percentage point increased probability of having Medicaid (95% CI, 6.1-11.1; P < .001). Medicaid expansion was associated with a 1.8-percentage point increase in the probability of early uncomplicated presentation (95% CI, 0.7-2.9; P = .001) and a 2.6-percentage point increase in the probability of receiving optimal management (95% CI, 0.8-4.4; P = .006). CONCLUSIONS AND RELEVANCEThe ACA's Medicaid expansion was associated with increased insurance coverage and improved receipt of timely care for 5 common surgical conditions. Health care systems and policymakers should be aware of the influence of insurance coverage expansion (or its repeal) on presentation with and management of surgical disease.

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“…Also, by way of example, major IBDI continue to occur in the Netherlands despite increasing adoption of the CVS technique (de Reuver, 2007). Gurusamy (Gurusamy, 2010), in a meta-analysis of randomized clinical trials of LCs for acute cholecystitis, reports lower IBDI rates in early treted patients (0,5%) compared to delayed interventions (1,4%). Minor IBDI rates are also decreased according to Yüksel (Yüksel, 2006) (3% vs 4,6%).…”

Section: Analysis Of Ibdi Incidencementioning

confidence: 99%

Iatrogenic Bile Duct Injuries Following Laparoscopic Cholecystectomy: Myth or Reality? A Recent Literature Review from 2006 to 2011

Conzo¹,

Napolitano²,

Candela³

et al. 2012

Cholestasis

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Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

Abstract: The correct legend to The publisher apologizes for any confusion caused.

Cited by 96 publications

References 0 publications

Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium

Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium

Association of the Affordable Care Act Medicaid Expansion With Access to and Quality of Care for Surgical Conditions

Iatrogenic Bile Duct Injuries Following Laparoscopic Cholecystectomy: Myth or Reality? A Recent Literature Review from 2006 to 2011

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