Failure to perform index cholecystectomy during acute cholecystitis results in significant morbidity for patients who present with recurrence. Issue 7 (July 2019)

• Record Type: Journal Article
• Authors: Escartín, Alfredo; González, Marta; Pinillos, Ana; Cuello, Elena; Muriel, Pablo; Tur, Jaume; Merichal, Mireia; Mestres, Nuria; Mías, María-Carmen; Olsina, Jorge-Juan
• Is Part Of: HPB. Volume 21:Issue 7(2019)
• Page Start: 876
• Page End: 882
• Publication Date: 2019-07
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2018.11.007
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Although index cholecystectomy is considered the treatment of choice for acute cholecystitis (AC), many hospital systems struggle to provide such a service. The aim of this study was to analyze the effect of failure to perform index cholecystectomy in patients presenting with acute cholecystitis. Methods: Between June 2010 and December 2015, all patients presenting to one hospital with an initial attack of AC were enrolled into a prospective database. Patient's records were reviewed up until point of delayed cholecystectomy or for a minimum of 24 months after the initial presentation with AC. Recurrent AC was defined as early (<6 weeks from initial discharge) or late (>6 weeks from initial discharge). Results: In total 998 patients presented with AC, 409 (41%) of whom were discharged without index cholecystectomy. Eighty-three (20%) patients presented with AC recurrence (ACR). Compared to the first AC episode, patients were more likely to present with grade III AC and suffer significantly greater morbidity (p < 0.05 for all comparisons). A prior history of biliary disease was associated with ACR (p = 0.002). ACR occurred early in 48 (58%) patients and delayed in 35 (42%) patients. Conclusions: Twenty percent of patients discharged without cholecystectomy after their first attack of ACR will develop recurrence within the first two years. Half of ACR will occur within 6 weeks. Patients who present with ACR are more likely to develop more severe AC and are likely to suffer greater morbidity as compared to their first attack.