PMID- 27649704 OWN - NLM STAT- MEDLINE DCOM- 20171229 LR - 20240213 IS - 1873-4626 (Electronic) IS - 1091-255X (Print) IS - 1091-255X (Linking) VI - 21 IP - 1 DP - 2017 Jan TI - The Sooner, the Better? The Importance of Optimal Timing of Cholecystectomy in Acute Cholecystitis: Data from the National Swedish Registry for Gallstone Surgery, GallRiks. PG - 33-40 LID - 10.1007/s11605-016-3223-y [doi] AB - Up-front cholecystectomy is the recommended therapy for acute cholecystitis (AC). However, the scientific basis for the definition of the optimal timing for surgery is scarce. The aim of this study was to analyze how the timing of surgery, after the admission to hospital for AC, affects the intra- and postoperative outcomes. Within the national Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks), all patients undergoing cholecystectomy for acute cholecystitis between January 2006 and December 2014 were identified. Data regarding patient characteristics, intra- and postoperative adverse events (AEs), bile duct injuries, and 30- and 90-day mortality risk were captured, and the correlation between the surgical timing and these parameters was analyzed. In total, data on 87,108 cholecystectomies were analyzed of which 15,760 (18.1 %) were performed due to AC. Bile duct injury, 30- and 90-day mortality risk, and intra- and postoperative AEs were significantly higher if the time from admission to surgery exceeded 4 days. The time course between surgery and complication risks seemed to be optimal if surgery was done within 2 days after hospital admission. Although AC patients operated on the day of hospital admission had a slightly increased AE rate as well as 30- and 90-day mortality rates than those operated during the interval of 1-2 days after admission, the bile duct injury and conversion rates were, in fact, significantly lower. The optimal timing of cholecystectomy for patients with AC seems to be within 2 days after admission. However, the somewhat higher frequency of AE on admission day may emphasize the importance of optimizing the patient before surgery as well as ensuring that adequate surgical resources are available. FAU - Blohm, My AU - Blohm M AD - Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. my.blohm@ltdalarna.se. AD - Department of Surgery, Mora Hospital, 792 85, Mora, Sweden. my.blohm@ltdalarna.se. FAU - Osterberg, Johanna AU - Osterberg J AD - Department of Surgery, Mora Hospital, 792 85, Mora, Sweden. FAU - Sandblom, Gabriel AU - Sandblom G AD - Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. AD - Center for Digestive Diseases, Karolinska University Hospital, 141 86, Stockholm, Sweden. FAU - Lundell, Lars AU - Lundell L AD - Center for Digestive Diseases, Karolinska University Hospital, 141 86, Stockholm, Sweden. FAU - Hedberg, Mats AU - Hedberg M AD - Department of Surgery, Mora Hospital, 792 85, Mora, Sweden. FAU - Enochsson, Lars AU - Enochsson L AUID- ORCID: 0000-0002-1930-654X AD - Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. lars.enochsson@ki.se. AD - Center for Digestive Diseases, Karolinska University Hospital, 141 86, Stockholm, Sweden. lars.enochsson@ki.se. LA - eng PT - Journal Article DEP - 20160920 PL - Netherlands TA - J Gastrointest Surg JT - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JID - 9706084 SB - IM MH - Adult MH - Aged MH - Bile Duct Diseases/epidemiology/etiology MH - Bile Ducts/injuries MH - Case-Control Studies MH - *Cholecystectomy/adverse effects/statistics & numerical data MH - Cholecystectomy, Laparoscopic/adverse effects/statistics & numerical data MH - Cholecystitis, Acute/epidemiology/*surgery MH - Female MH - Humans MH - Male MH - Middle Aged MH - Registries MH - Sweden/epidemiology MH - Time Factors PMC - PMC5187360 OTO - NOTNLM OT - Acute cholecystitis OT - Admission day OT - Adverse events OT - Bile duct injury OT - Laparoscopic cholecystectomy OT - Open cholecystectomy COIS- Compliance with Ethical StandardsConflict of InterestThe authors declare that they have no conflict of interest.Author contributionsMB, JO, GS, and LE conceived of the study and design the study. MB and LE performed the data acquisition. MB, JO, GS, MH, LL, and LE performed the quality control of data and algorithms. MB, JO, MH, and LE performed the data analysis and interpretation, GS and LE performed the statistical analysis. MB, JO, GS, LL, MH, and LE prepared, edited, and reviewed the manuscript. All authors have approved of the final draft submitted. EDAT- 2016/09/22 06:00 MHDA- 2017/12/30 06:00 PMCR- 2016/09/20 CRDT- 2016/09/22 06:00 PHST- 2016/05/14 00:00 [received] PHST- 2016/07/22 00:00 [accepted] PHST- 2016/09/22 06:00 [pubmed] PHST- 2017/12/30 06:00 [medline] PHST- 2016/09/22 06:00 [entrez] PHST- 2016/09/20 00:00 [pmc-release] AID - S1091-255X(23)02190-X [pii] AID - 3223 [pii] AID - 10.1007/s11605-016-3223-y [doi] PST - ppublish SO - J Gastrointest Surg. 2017 Jan;21(1):33-40. doi: 10.1007/s11605-016-3223-y. Epub 2016 Sep 20.