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

  • 2019 SAGES Oral
  • Published:
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Abstract

Introduction

The timing of cholecystectomy for acute cholecystitis has been debated with most studies favoring early cholecystectomy (< 72 h of onset). However, most reported studies are from single institution studies with only a few population-based studies. The purpose of this study is to compare clinical outcomes of patients undergoing cholecystectomy within 72 h of emergency department (ED) presentation to patients undergoing cholecystectomy following 72 h in a large statewide database.

Methods

The New York SPARCS administrative database was used to identify all adult patients presenting to the ED with a diagnosis of acute cholecystitis from 2005 to 2016. Patients aged < 18, missing data, or other biliary diagnoses were excluded from the analysis. Early cholecystectomy was defined as within 72 h of presentation to the emergency department. Early vs late groups were compared in terms of overall complications, bile duct injury (BDI), 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 complications, BDI, and 30-day readmission/ED visits 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 an ED with the diagnosis of acute cholecystitis. The majority of patients underwent 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 (81.1%) to 2016 (87.8%). On multivariable 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 bile duct injury (OR 0.654, 95% CI 0.444–0.962) compared to late cholecystectomy patients.

Conclusion

Early cholecystectomy (< 72 h) is associated with fewer complications, specifically BDI, shorter LOS, and fewer 30-day readmissions and ED visits. For patients presenting to the ED for acute cholecystitis, early cholecystectomy should be preferred.

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Acknowledgement

We acknowledge the biostatistical consultation and support provided by the Biostatistical Consulting Core at School of Medicine, Stony Brook University.

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Authors and Affiliations

  1. Minimally Invasive Surgery, Washington University School of Medicine, 660 Euclid Ave, Campus Box 8109, St. Louis, MO, 63110, USA

    Maria S. Altieri & L. Michael Brunt

  2. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA

    Mark A. Talamini & Aurora D. Pryor

  3. Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

    Jie Yang

  4. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA

    Chencan Zhu

Authors
  1. Maria S. Altieri
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  2. L. Michael Brunt
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  5. Mark A. Talamini
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Corresponding author

Correspondence to Maria S. Altieri.

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Disclosures

Dr. Pryor is a speaker for Ethicon, Gore, Merck and Stryker, and Medtronic. She has research support from Baronova and Obalon. Dr. Talamini is a consultant for Stryker. For the remaining authors, Dr. Altieri, Dr. Yang, Dr. Michael Brunt, and Ms. Zhu none are declared.

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464_2019_7049_MOESM1_ESM.docx

Table 3: Multivariable Logistic Regression Analysis comparing of early vs late cholecystectomy in any complication. *: P-values were based on type 3 test of multivariable logistic regression. Supplementary material 1 (DOCX 13 kb)

464_2019_7049_MOESM2_ESM.docx

Table 4: Multivariable Linear Regression Analysis comparing LOS between early vs late cholecystectomy assuming that LOS had a negative binomial distribution. *: P-values were based on type 3 test of generalized linear regression assuming negative binomial distribution. Supplementary material 2 (DOCX 13 kb)

464_2019_7049_MOESM3_ESM.docx

Table 5: Multivariable Logistic Regression Analysis comparing 30-day readmission between early vs late cholecystectomy. *: P-values were based on type 3 test of multivariable logistic regression. Supplementary material 3 (DOCX 13 kb)

464_2019_7049_MOESM4_ESM.docx

Table 6: Multivariable Logistic Regression Analysis comparing 30-day ED visits between early vs late cholecystectomy. *: P-values were based on type 3 test of multivariable logistic regression. Supplementary material 4 (DOCX 13 kb)

464_2019_7049_MOESM5_ESM.docx

Table 7: Multivariable Logistic Regression Analysis comparing BDI injury between early vs late cholecystectomy. *: P-values were based on type 3 test of multivariable logistic regression after forward selection. Supplementary material 5 (DOCX 12 kb)

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Altieri, M.S., Brunt, L.M., Yang, J. et al. Early cholecystectomy (< 72 h) is associated with lower rate of complications and bile duct injury: a study of 109,862 cholecystectomies in the state of New York. Surg Endosc 34, 3051–3056 (2020). https://doi.org/10.1007/s00464-019-07049-6

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  • DOI: https://doi.org/10.1007/s00464-019-07049-6

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