Outcomes after early vs interval cholecystectomy for perforated Cholecystitis:A multicenter cohort study.

INTRODUCTION

Gallbladder perforation is rare and carries significant morbidity. The optimal timing of cholecystectomy in patients with perforated cholecystitis is debated.

METHODS

A multi-institutional retrospective review of patients undergoing cholecystectomy for perforated cholecystitis from 2014 to 2023 was performed. Presenting characteristics, operative details, and short-term outcomes were compared between patients undergoing early (same-admission) vs interval cholecystectomy.

RESULTS

Of 230 patients included, 201 (87.4 ​%) underwent early cholecystectomy (EC), while 29 (12.6 ​%) underwent interval cholecystectomy (IC). Patients undergoing IC were more likely to require an open surgery (55.2 ​% vs 35.3 ​%, p ​= ​0.04) and more likely to develop a surgical site infection (17.2 ​% vs 4.0 ​%, p ​= ​0.01), even after adjusting for surgical approach (aOR 3.8, 95 ​% CI 1.1-13.3, p ​= ​0.04). Total hospital length of stay (including index hospitalizations in the IC group) was longer for patients undergoing IC (median 8 days vs 5 days, p ​= ​0.02). Thirty-day biliary complications, reinterventions, and readmissions were similar between groups.

CONCLUSION

Our study suggests EC for perforated cholecystitis is safe and may be preferable to IC with fewer open surgeries, surgical site infections, and shorter overall hospital stay.