James X Wu1, Andrew T Nguyen2, Christian de Virgilio3, David S Plurad2, Amy H Kaji2, Virginia Nguyen2, Edward Gifford2, Michael de Virgilio2, Reed Ayabe2, Darin Saltzman1, Dennis Kim4. 1. Department of Surgery, Olive View - UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 2. Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA. 3. Department of Surgery, Olive View - UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA. 4. Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA. Electronic address: dekim@dhs.lacounty.gov.
Abstract
BACKGROUND: The urgency of laparoscopic cholecystectomy for acute cholecystitis is under debate. We hypothesized that nighttime cholecystectomy is associated with decreased length of stay. METHODS: Retrospective review of 1,140 patients at 2 large urban referral centers with acute cholecystitis who underwent daytime (7 am to 7 pm) versus nighttime (7 pm to 7 am) cholecystectomy was conducted. RESULTS: Nighttime cholecystectomy did not affect the overall length of stay (3.7 vs 3.8 days, P = .08) or complication rate (5% vs 7%, P = .5) versus daytime cholecystectomy. Nighttime cholecystectomy was associated with a higher conversion rate to open cholecystectomy (11% vs 6%, P = .008). On multivariable analysis, independent predictors of conversion to open surgery were nighttime cholecystectomy, age, and gangrenous cholecystitis (P = .01). The only predictor of complications was gangrenous cholecystitis (P = .02). CONCLUSIONS: Nighttime cholecystectomy is associated with an increased conversion to open surgery without decrease in length of stay or complications. These findings suggest that laparoscopic cholecystectomy for acute cholecystitis should be delayed until normal working hours.
BACKGROUND: The urgency of laparoscopic cholecystectomy for acute cholecystitis is under debate. We hypothesized that nighttime cholecystectomy is associated with decreased length of stay. METHODS: Retrospective review of 1,140 patients at 2 large urban referral centers with acute cholecystitis who underwent daytime (7 am to 7 pm) versus nighttime (7 pm to 7 am) cholecystectomy was conducted. RESULTS: Nighttime cholecystectomy did not affect the overall length of stay (3.7 vs 3.8 days, P = .08) or complication rate (5% vs 7%, P = .5) versus daytime cholecystectomy. Nighttime cholecystectomy was associated with a higher conversion rate to open cholecystectomy (11% vs 6%, P = .008). On multivariable analysis, independent predictors of conversion to open surgery were nighttime cholecystectomy, age, and gangrenous cholecystitis (P = .01). The only predictor of complications was gangrenous cholecystitis (P = .02). CONCLUSIONS: Nighttime cholecystectomy is associated with an increased conversion to open surgery without decrease in length of stay or complications. These findings suggest that laparoscopic cholecystectomy for acute cholecystitis should be delayed until normal working hours.
Authors: Varun Puri; Ramsey R Hachem; Christian Corbin Frye; Margaret Shea Harrison; Tara R Semenkovich; John P Lynch; Gene Ridolfi; Casey Rowe; Bryan F Meyers; George Alexander Patterson; Benjamin D Kozower; Michael K Pasque; Ruben G Nava; Gary F Marklin; Diane Brockmeier; Stuart C Sweet; William C Chapman; Daniel Kreisel Journal: Am J Transplant Date: 2019-03-18 Impact factor: 8.086