Published online Dec 28, 2019. doi: 10.3748/wjg.v25.i48.6916
Peer-review started: November 4, 2019
First decision: December 12, 2019
Revised: December 17, 2019
Accepted: December 22, 2019
Article in press: December 22, 2019
Published online: December 28, 2019
The timeframe of when to perform cholecystectomy for acute cholecystitis has been controversial for years. Most recently, clinical practice has favored operative intervention during the same admission (SA) (early cholecystectomy). We present a comparison of complications between SA vs interval (delayed) cholecystectomy.
Recent enthusiasm for SA cholecystectomy is based on projected economic advantage. We hypothesized that the economic advantage may be lost if complication rates are higher than expected.
We compared the complication rates and hospital charges between SA vs delayed cholecystectomy patients. Patients were stratified by Tokyo Grade.
We performed a retrospective chart review of all patients at a single institution who presented for cholecystectomy due to acute cholecystitis between February 2010 through August 2018. Hospital charges were also obtained when available. Descriptive statistics were used to compare the groups; a multivariate model on the covariates predicting complications was also performed.
SA cholecystectomy patients had an overall complication rate of 18.5% compared to Delayed cholecystectomy patients with a complication rate of 4.4% (P = 0.004). For the Tokyo Grade 2 patients (moderate disease), SA and delayed cholecystectomy complication rates were 16% vs 0%, respectively (P < 0.001). SA cholecystectomy hospital charges were higher compared to Delayed cholecystectomy (P = 0.019) due to an increase in cost from the management of complications. There were no significant differences in clinical outcomes for Tokyo Grade 1 patients (mild disease). We did not have sufficient numbers of patients with Tokyo Grade 3 (severe disease) for meaningful comparisons.
Our study demonstrates that SA cholecystectomy patients have higher complication rates with associated higher costs. The data supports a selective approach to operative intervention for acute cholecystitis; Tokyo Grade 2 patients have a lower complication rate when cholecystectomy is Delayed. Risk factors for complications include Tokyo Grade 2 severity of disease. In a risk analysis, among eight patients with acute cholecystitis undergoing SA cholecystectomy, one patient will suffer a complication.
This study suggests that SA cholecystectomy does not always afford an economic advantage, especially if there are complications. Future studies are needed to confirm our findings since this study is limited because the data was collected retrospectively from a single institution.