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
Research background

The timeframe of when to perform cholecystectomy for acute cholecystitis has been controversial for years. Most recently, clinical practice has favored operative intervention during the same admission (SA) (early cholecystectomy). We present a comparison of complications between SA vs interval (delayed) cholecystectomy.

Research motivation

Recent enthusiasm for SA cholecystectomy is based on projected economic advantage. We hypothesized that the economic advantage may be lost if complication rates are higher than expected.

Research objectives

We compared the complication rates and hospital charges between SA vs delayed cholecystectomy patients. Patients were stratified by Tokyo Grade.

Research methods

We performed a retrospective chart review of all patients at a single institution who presented for cholecystectomy due to acute cholecystitis between February 2010 through August 2018. Hospital charges were also obtained when available. Descriptive statistics were used to compare the groups; a multivariate model on the covariates predicting complications was also performed.

Research results

SA cholecystectomy patients had an overall complication rate of 18.5% compared to Delayed cholecystectomy patients with a complication rate of 4.4% (P = 0.004). For the Tokyo Grade 2 patients (moderate disease), SA and delayed cholecystectomy complication rates were 16% vs 0%, respectively (P < 0.001). SA cholecystectomy hospital charges were higher compared to Delayed cholecystectomy (P = 0.019) due to an increase in cost from the management of complications. There were no significant differences in clinical outcomes for Tokyo Grade 1 patients (mild disease). We did not have sufficient numbers of patients with Tokyo Grade 3 (severe disease) for meaningful comparisons.

Research conclusions

Our study demonstrates that SA cholecystectomy patients have higher complication rates with associated higher costs. The data supports a selective approach to operative intervention for acute cholecystitis; Tokyo Grade 2 patients have a lower complication rate when cholecystectomy is Delayed. Risk factors for complications include Tokyo Grade 2 severity of disease. In a risk analysis, among eight patients with acute cholecystitis undergoing SA cholecystectomy, one patient will suffer a complication.

Research perspectives

This study suggests that SA cholecystectomy does not always afford an economic advantage, especially if there are complications. Future studies are needed to confirm our findings since this study is limited because the data was collected retrospectively from a single institution.