Maxime Polo1, Antoine Duclos2,3,4, Stéphanie Polazzi2, Cécile Payet2, Jean Christophe Lifante1,2,3, Eddy Cotte1,2,3, Xavier Barth5, Olivier Glehen1,2,3, Guillaume Passot6,7,8. 1. Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France. 2. Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France. 3. EMR 3738 Université Lyon 1, F-69364, Lyon, France. 4. Center for Surgery and Public Health, Brigham and Women's Hospital-Harvard Medical School, Boston, MA, USA. 5. Department of General Surgery, Hospices Civils de Lyon, Hop Ed. Herriot, 69003, Lyon, France. 6. Department of General and Surgical Oncology, CH Lyon Sud, Hospices Civiles de Lyon, 69495, Pierre Bénite, France. guillaume.passot@chu-lyon.fr. 7. Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, F-69003, Lyon, France. guillaume.passot@chu-lyon.fr. 8. EMR 3738 Université Lyon 1, F-69364, Lyon, France. guillaume.passot@chu-lyon.fr.
Abstract
BACKGROUND: The recommended treatment for acute calculous cholecystitis combines antibiotics and cholecystectomy. To reduce morbidity and mortality, guidelines recommend early cholecystectomy. However, the optimal timing for surgery on first admission remains controversial. This study aims to determine the best timing for cholecystectomy in patients presenting with acute calculous cholecystitis. STUDY DESIGN: The French national health-care database was analyzed to identify all patients undergoing cholecystectomy for acute cholecystitis during the same hospital stay between January 2010 and December 2013. Data regarding patients, procedures, and hospitals characteristics were collected. The relationship between surgery's timing and clinical outcome was evaluated by multiple logistic regressions. RESULTS: Overall, 42,452 patients from 507 hospitals were included in the study. Postoperative complications requiring invasive treatment occurred in 961 patients (2.3 %), and the mortality rate was 1.1 %. Adverse postoperative outcomes-intensive care admission, reoperation, and postoperative sepsis-were significantly lower when surgery was performed between days 1 and 3 (3-3.3, 0.5-0.6, and 3.8-4.1 %, respectively) when compared to surgery performed on the day of admission (5.6, 1.2, and 5.2 %, p < 0.001) or from day 5 onward (4.5, 1, and 6.5 %, respectively; p < 0.001). Mortality was also significantly lower in patients undergoing cholecystectomy between days 1 and 3 after admission (0.8-1 %) when compared to patients operated on the day of admission or after day 3 (1.4 % on day 0, 1.2 % on day 4, and 1.9 % from day 5: all p < 0.001). CONCLUSION: For patients with acute calculous cholecystitis, all efforts should be made to perform cholecystectomy within 3 days after hospital admission in order to decrease morbidity and mortality.
BACKGROUND: The recommended treatment for acute calculous cholecystitis combines antibiotics and cholecystectomy. To reduce morbidity and mortality, guidelines recommend early cholecystectomy. However, the optimal timing for surgery on first admission remains controversial. This study aims to determine the best timing for cholecystectomy in patients presenting with acute calculous cholecystitis. STUDY DESIGN: The French national health-care database was analyzed to identify all patients undergoing cholecystectomy for acute cholecystitis during the same hospital stay between January 2010 and December 2013. Data regarding patients, procedures, and hospitals characteristics were collected. The relationship between surgery's timing and clinical outcome was evaluated by multiple logistic regressions. RESULTS: Overall, 42,452 patients from 507 hospitals were included in the study. Postoperative complications requiring invasive treatment occurred in 961 patients (2.3 %), and the mortality rate was 1.1 %. Adverse postoperative outcomes-intensive care admission, reoperation, and postoperative sepsis-were significantly lower when surgery was performed between days 1 and 3 (3-3.3, 0.5-0.6, and 3.8-4.1 %, respectively) when compared to surgery performed on the day of admission (5.6, 1.2, and 5.2 %, p < 0.001) or from day 5 onward (4.5, 1, and 6.5 %, respectively; p < 0.001). Mortality was also significantly lower in patients undergoing cholecystectomy between days 1 and 3 after admission (0.8-1 %) when compared to patients operated on the day of admission or after day 3 (1.4 % on day 0, 1.2 % on day 4, and 1.9 % from day 5: all p < 0.001). CONCLUSION: For patients with acute calculous cholecystitis, all efforts should be made to perform cholecystectomy within 3 days after hospital admission in order to decrease morbidity and mortality.
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