Outcomes following out-of-hours acute cholecystectomy: A systematic review and meta-analysis.

Abstract

BACKGROUND\nCholecystectomy is one of the most commonly performed abdominal operations. Rising demands on acute operating theatre availability and resource utilization in the daytime have led to acute cholecystectomy being performed out-of-hours (in the evenings, at night, or on weekends), although it remains unknown whether outcomes differ between out-of-hours and in-hours (during the daytime on weekdays) acute cholecystectomy. This systematic review and meta-analysis aimed to compare outcomes following out-of-hours versus in-hours acute cholecystectomy.\n\n\nMETHODS\nThe study protocol was prospectively registered on PROSPERO (ID:CRD42021226127). MEDLINE, EMBASE, and Scopus databases were systematically for studies comparing outcomes following out-of-hours and in-hours acute cholecystectomy in adults with any acute benign gallbladder disease. The outcomes of interest were rates of bile leakage, bile duct injury (BDI), overall post-operative complications, conversion to open cholecystectomy, specific intra- and post-operative complications, length of stay (LOS), readmission and mortality. Subgroup (evening/night-time vs. daytime, weekend vs. weekday, acute surgical unit (ASU)-only, non-ASU, and laparoscopic-only) and sensitivity analyses of adjusted multivariate regression analysis results was also performed.\n\n\nRESULTS\nEleven studies were included. There were no differences between out-of-hours and in-hours acute cholecystectomy for rates of bile leakage, BDI, overall post-operative complications, conversion to open cholecystectomy, operative duration, readmission, mortality, and post-operative LOS. Higher rates of post-operative sepsis (odds ratio (OR) 1.58, 95% CI: 1.04-2.41; p = 0.03) and pneumonia (OR 1.55, 95% CI: 1.06-2.26; p = 0.02) were observed following out-of-hours acute cholecystectomy on univariate meta-analysis, but not after the adjusted multivariate meta-analysis. Higher conversion rates were observed when out-of-hours cholecystectomy was performed in centres without an ASU.\n\n\nCONCLUSIONS\nThis systematic review and meta-analysis has not shown an increased risk in overall or specific complications associated with out-of-hours compared with in-hours acute cholecystectomy. However, future studies should assess the potential impact of structural hospital factors, such as an ASU, on outcomes following out-of-hours acute cholecystectomy.\n\n\nLEVEL OF EVIDENCE\nIV.