Prolonged preoperative length of stay may be associated with an increased risk of complications in patients with acute cholecystitis.

Background

Acute cholecystitis is the most common complication of gallstone disease. Although early cholecystectomy is recommended, surgery is frequently delayed in clinical practice. This study aimed to evaluate the association between preoperative length of stay and postoperative complications following cholecystectomy for acute cholecystitis. In addition, reasons for delayed surgery were assessed.

Methods

This multicenter retrospective cohort study included consecutive patients undergoing laparoscopic cholecystectomy for acute cholecystitis between January 1, 2018, and December 31, 2022. Preoperative length of stay was defined as the time from admission to surgery. Postoperative complications were classified according to the Clavien-Dindo classification, and diagnosis and severity of acute cholecystitis were defined according to the Tokyo Guidelines.

Results

A total of 1,544 consecutive patients were included. After adjustment for age, body mass index, ASA classification, performance status, Tokyo Guidelines severity, symptom duration, and treating hospital, each additional preoperative hospital day was associated with higher odds of postoperative complications requiring pharmacological or surgical treatment (Clavien-Dindo ≥2) (OR 1.14, 95% CI 1.01-1.29). Surgery performed more than 3 days after admission was associated with higher odds of complications compared with surgery within 3 days (OR 1.98, 95% CI 1.18-3.35). ASA score ≥3, higher Tokyo Guidelines severity grade, and impaired performance status were independent predictors of postoperative complications.

Conclusion

Longer preoperative length of stay was associated with higher postoperative morbidity following cholecystectomy for acute cholecystitis. Surgery performed more than 3 days after admission was associated with increased odds of postoperative complications. These findings support efforts to minimize in-hospital delays, although residual confounding inherent to the observational study design cannot be excluded.