Delayed Cholecystectomy for Acute Cholangitis Linked to Worse Outcomes: Study
Researchers have found that compared to surgery done at index admission, delayed cholecystectomy for acute cholangitis did have much worse postoperative outcomes. A latest study published by Ayesha P. and colleagues in The American Journal of Surgery. This study compares the outcome when cholecystectomy is performed during the initial admission versus a delayed admission for acute cholangitis, using data from the Nationwide Readmissions Database covering 2011-2020.
This was a retrospective study of 65,753 adult patients admitted for acute cholangitis who had undergone cholecystectomy. Patients were stratified as index, if the surgery was performed during the index admission, or delayed, if the surgery occurred after the index admission. The impact of timing of cholecystectomy on several outcomes was assessed by Royston-Parmar time-adjusted analyses using multivariable regression.
Key Findings
• Out of 65,753 patients, 82% had cholecystectomy during the index admission, while 18% had the procedure delayed.
• Delayed surgery was linked to a 67% increased odds of mortality (Adjusted Odds Ratio [AOR] 1.67, 95% Confidence Interval [CI] 1.10-2.54).
• Delayed cholecystectomy was associated with a 25% higher likelihood of complications (AOR 1.25, 95% CI 1.13-1.40), and a 69% increased chance of conversion to an open surgical procedure (AOR 1.69, 95% CI 1.48-1.93).
• The risk of bile duct injury repair was 66% higher in the delayed group (AOR 1.66, 95% CI 1.15-2.41), and 30-day readmission rates were more than three times higher (AOR 3.52, 95% CI 3.21-3.86).
• Patients with delayed cholecystectomy incurred an average additional cost of $14,200 compared to those who had surgery during their index admission.
The findings of this study are that delayed cholecystectomy for acute cholangitis is associated with poorer outcomes, including increased mortality and more complications, besides an increased conversion to open surgery, along with higher costs. Under these circumstances, considering the data presented, cholecystectomy during the index admission could be a safer and more cost-effective strategy. Further studies should be done to confirm these results and optimize treatment protocols for acute cholangitis.
Reference:
Ng, A. P., Seo, Y.-J., Ali, K., Coaston, T., Mallick, S., de Virgilio, C., & Benharash, P. (2024). National analysis of outcomes in timing of cholecystectomy for acute cholangitis. American Journal of Surgery, 115851, 115851. https://doi.org/10.1016/j.amjsurg.2024.115851
