Elsevier

Journal of Surgical Research

Volume 219, November 2017, Pages 253-258
Journal of Surgical Research

Emergency Surgery
Prolonged length of stay in delayed cholecystectomy is not due to intraoperative or postoperative contributors

https://doi.org/10.1016/j.jss.2017.05.100Get rights and content

Abstract

Background

Previous studies have reported that same-day laparoscopic cholecystectomy for acute cholecystitis is superior to delayed elective cholecystectomy. Although this practice is ideal, it requires significant hospital resources, particularly for an underprivileged inner-city population at a large, municipal hospital. We sought to evaluate the implementation of same-day laparoscopic cholecystectomy in a large, municipal hospital and assess the possible benefits of decreasing preoperative length of stay (LOS), particularly its effect on operative time and length of stay in patients with acute cholecystitis.

Materials and Methods

This was a retrospective chart review of patients treated for symptomatic gallstone disease between September 2012 and November 2013. Medical records were reviewed, and relevant data points were collected. Univariate and multivariate regressions were performed to assess the correlation between time to operation (<36 h [no delay] or >36 h [delay]) and the main outcomes (operative time and total length of stay). Inclusion criteria were patients age ≥18 y who underwent same-admission cholecystectomy and had a diagnosis of cholecystitis on pathology. Eighty-eight patients met all inclusion criteria.

Results

The mean (standard deviation) preoperative LOS was 76.2 (±48.6) h, the mean operative time was 2.3 (±1.1) h, and the mean postoperative LOS was 60.3 (±60.1) h. The average total LOS was 136 (±79.8) h. Operative times and postoperative LOS were similar for patients in the delay and no delay groups. Patients with >36 h wait before surgery had a total length of stay twice as long as patients with <36 h wait (152 versus 83.3 h; P = 0.0005). These findings remained significant when adjusted for age, sex, radiologic findings, number of preoperative tests, and pathology.

Conclusions

Increased preoperative LOS is not associated with a significant increase in operative time. However, it was associated with significantly increased length of stay. Further analysis is needed to explore the potential cost savings of decreasing preoperative LOS.

Section snippets

Background

Gallstone disease affects approximately 10% of the population in the United States and is one of the leading causes of hospital admission.1, 2 The standard of care for symptomatic gallstone disease is laparoscopic cholecystectomy (LC) with over 700,000 cholecystectomies performed each year.1, 2 For patients with acute cholecystitis, 89.0% are admitted to the hospital as an emergency and 67.1% of these patients undergo LC during that admission.3 The timing of surgical intervention has

Methods

This was a retrospective chart review of patients treated for symptomatic gallstone disease at Bellevue Hospital Center (BHC), between September 2012 and November 2013. BHC is a large city hospital in New York City with a robust surgical residency program. Inclusion criteria for this study were patients 18 y or older who underwent same-admission cholecystectomy and were diagnosed with cholecystitis on pathology. Patients were excluded if they were younger than 18 y or had a postoperative

Results

Of the 88 patients included in this study, there were 57 women and 31 men. The average (standard deviation) age was 42 (13.3) y (Table 1). Most patients (68) received an ultrasound (US); 45 patients had a computed tomographic (CT) scan; 21 patients had an endoscopic retrograde cholangiopancreatography (ERCP); three patients had a magnetic resonance cholangiopancreatography (MRCP). Thirty-five patients underwent two preoperative studies (21 received US and CT scan; 8 received CT scan and ERCP; 5

Discussion

The findings of our study show that decreased preoperative length of stay before same-admission laparoscopic cholecystectomy is not associated with a statistically significant decrease in operative time. Our results also show that delay to the OR is associated with increased total LOS, not attributable to operative time or postoperative LOS. Similar findings were published by Zafar et al., who found that days to LC was not associated with increased postoperative length of stay after risk

Acknowledgment

Authors' contributions: Study concept and design were performed by P.A.-C., M.B., K.R., and C.W. Acquisition of data was performed by M.B. Statistical analysis and interpretation of data were performed by P.A.-C., M.B., C.D., K.R., and C.W. Drafting of the article and critical revision were performed by P.A.-C., M.B., C.D., K.R., and C.W. Study supervision was performed by P.A.-C.

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Cited by (1)

Presented at the 74th Annual Meeting of the Association for the Surgery of Trauma & Clinical Congress of Acute Care Surgery.

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