Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2019; 25(48): 6916-6927
Published online Dec 28, 2019. doi: 10.3748/wjg.v25.i48.6916
Operative complications and economic outcomes of cholecystectomy for acute cholecystitis
Christopher P Rice, Krishnamurthy B Vaishnavi, Celia Chao, Daniel Jupiter, August B Schaeffer, Whitney R Jenson, Lance W Griffin, William J Mileski
Christopher P Rice, Krishnamurthy B Vaishnavi, August B Schaeffer, School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
Celia Chao, Whitney R Jenson, Lance W Griffin, William J Mileski, Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
Daniel Jupiter, Department of Preventive Medicine and Community Health, Department of Biostatistics, University of Texas Medical Branch, Galveston, TX 77555, United States
Author contributions: Rice CP, Vaishnavi KB, Chao C, Jenson WR, Griffin LW and Mileski WJ contributed to the conception and design of the study; Rice CP, Vaishnavi KB, Chao C and Jenson WR assisted with data acquisition; Rice CP, Chao C, Jupiter D and Mileski WJ analyzed and interpreted the data obtained; Rice CP, Chao C, Schaeffer AB, Jupiter D and Mileski WJ drafted the article and/or made critical revisions related to important intellectual content of the manuscript; all authors contributed to the proof-reading and final approval of the version of the article to be published.
Institutional review board statement: This study was approved by the UTMB Institutional Review Board, No. 18-0042.
Informed consent statement: This manuscript is a retrospective study, therefore, signed informed consent forms are not necessary.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: William J Mileski, MD, FACS, Chief Doctor, Professor, Surgeon, Division of Trauma and Acute Care Surgery, Department of Surgery, University of Texas Medical Branch; 301 University Boulevard, Galveston, TX 77555, United States.
Received: November 4, 2019
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

Recent management of acute cholecystitis favors same admission (SA) or emergent cholecystectomy based on overall shorter hospital stay and therefore cost savings. We adopted the practice of SA cholecystectomy for the treatment of acute cholecystitis at our tertiary care center and wanted to evaluate the economic benefit of this practice. We hypothesized that the existence of complications, particularly among patients with a higher degree of disease severity, during SA cholecystectomy could negate the cost savings.


To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute cholecystitis.


Under an IRB-approved protocol, complications and charges for were obtained for SA, later after conservative management (Delayed), or elective cholecystectomies over an 8.5-year period. Patients were identified using the acute care surgery registry and billing database. Data was retrieved via EMR, operative logs, and Revenue Cycle Operations. The severity of acute cholecystitis was graded according to the Tokyo Guidelines. TG18 categorizes acute cholecystitis by Grades 1, 2, and 3 representing mild, moderate, and severe, respectively. Comparisons were analyzed with χ2, Fisher’s exact test, ANOVA, t-tests, and logistic regression; significance was set at P < 0.05.


Four hundred eighty-six (87.7%) underwent a SA while 68 patients (12.3%) received Delayed cholecystectomy. Complication rates were increased after SA compared to Delayed cholecystectomy (18.5% vs 4.4%, P = 0.004). The complication rates of patients undergoing delayed cholecystectomy was similar to the rate for elective cholecystectomy (7.4%, P = 0.35). Mortality rates were 0.6% vs 0% for SA vs Delayed. Patients with moderate disease (Tokyo 2) suffered more complications among SA while none who were delayed experienced a complication (16.1% vs 0.0%, P < 0.001). Total hospital charges for SA cholecystectomy were increased compared to a Delayed approach ($44500 ± $59000 vs $35300 ± $16700, P = 0.019). The relative risk of developing a complication was 4.2x [95% confidence interval (CI): 1.4-12.9] in the SA vs Delayed groups. Among eight patients (95%CI: 5.0-12.3) with acute cholecystitis undergoing SA cholecystectomy, one patient will suffer a complication.


Patients with Tokyo Grade 2 acute cholecystitis had more complications and increased hospital charges when undergoing SA cholecystectomy. This data supports a selective approach to SA cholecystectomy for acute cholecystitis.

Keywords: Acute cholecystitis, Tokyo guidelines, Cholecystectomy, Complications, Delayed cholecystectomy

Core tip: Patients presenting with acute cholecystitis (Tokyo Grade 2) have more complications and increased hospital charges when undergoing same admission cholecystectomy. This data supports a selective approach; greater disease severity may have a lower complication rate when surgery is delayed.