Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2015
Acute Cholecystitis-Optimal Timing for Early Cholecystectomy: a French Nationwide Study.
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Polo Maxime, Duclos Antoine, Polazzi Stéphanie, Payet Cécile, Lifante Jean Christophe, Cotte Eddy, Barth Xavier, Glehen Olivier, Passot Guillaume
Аннотация
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.
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.