Acute biliary pathology: Is urgent cholecystectomy performed in the correct timing?

Background and aim:The optimal time to perform Laparoscopic Cholecystectomy (LC) was unclear untiI in 2020, when WSES recommended Early laparoscopic cholecystectomy (ELC). LC is associated with a significant reduction in recurrent biliary complications and hospital re-admission. The aim of this study is to assess the influence of waiting time (WT) before surgery on post operative length of stay (LOS).

Methods: Data from patients undergoing cholecystectomy in urgent timing in two hospitals were collected: Milano and Trieste. We considered as ELC when performed within 48 hours from the diagnosis.

Results: 170 patients, 70.0% with acute cholecystitis. Surgical approach as first line of therapy in 75.3%. The median LOS was 6.00 days, the WT 1.00. ELC in 58.2%, most frequently performed in Trieste, conversion rate 13.5%. LOS is 5 days while WT is 0 days. In Milano conversion rate of 2.5%, median LOS 7 days, with WT of 2. ELC in 34.6%. In multivariate analysis, the variables confirmed to be related to LOS are postoperative complications (p = 0.001); WT (p< 0.001).

Conclusions: LOS depends on the WT and ELC. LOS is significantly shorter in the ELC group not significantly related to the conversion rate. Making patients wait to access the operating room not only entails clinical repercussions on the patient (in terms of risk of postoperative complications) but also it creates an economic impact for the hospital. We have shown that a patient who waits less from the moment of diagnosis to arrive in the operating room, spends less time in the hospital and has less risk of experiencing post operative complications. The WT is a fundamental factor, emphasizing how making the patient wait longer for the operation then forces him to have a longer hospitalization, also affecting healthcare costs. More needs to be done to improve the situation of access to operating theaters for these patients.

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