Surgical and financial impact of delayed cholecystectomy in mild and moderate acute cholecystitis

Abstract

Emergency cholecystectomy (EC) for acute cholecystitis (AC) has developed an increasing interest in recent years but is still not widely employed in the UK. This study aims to address the impact of delayed cholecystectomy (DC) for mild and moderate AC, with a special focus on the financial aspect, which has not been discussed much in the literature. In this prospective cohort study, we included two groups of patients in whom cholecystectomy was performed for mild or moderate cholecystitis between March and September 2018. The first group included all patients who underwent EC while the second included patients who underwent elective cholecystectomy following a previous admission with AC. Operative complications, length of stay (LOS), number of investigations, and the financial difference between both groups were compared. There were 45 patients in each group. In the DC group, 7 patients (15%) had their laparoscopic cholecystectomies converted to open, and 5 (11%) developed postoperative complications (one postoperative bleeding requiring emergency laparotomy, one biliary leakage treated with biliary stenting, and three postoperative infected collections). While awaiting DC, 19 patients (42%) were readmitted with gallstone complications. The total LOS for hospital readmissions was 98 days vs. 5 days in the EC group. The estimated cost of the repeated admissions and reinvestigations in the DC group was £\u202f71,456. There was one postoperative complication in the EC group. Delayed cholecystectomy for mild and moderate cholecystitis was associated with more operative complications and extra financial costs compared to emergency cholecystectomy.