Advertisement

Can it wait until morning? A comparison of nighttime versus daytime cholecystectomy for acute cholecystitis

Published:September 20, 2014DOI:https://doi.org/10.1016/j.amjsurg.2014.09.004

      Abstract

      Background

      The urgency of laparoscopic cholecystectomy for acute cholecystitis is under debate. We hypothesized that nighttime cholecystectomy is associated with decreased length of stay.

      Methods

      Retrospective review of 1,140 patients at 2 large urban referral centers with acute cholecystitis who underwent daytime (7 am to 7 pm) versus nighttime (7 pm to 7 am) cholecystectomy was conducted.

      Results

      Nighttime cholecystectomy did not affect the overall length of stay (3.7 vs 3.8 days, P = .08) or complication rate (5% vs 7%, P = .5) versus daytime cholecystectomy. Nighttime cholecystectomy was associated with a higher conversion rate to open cholecystectomy (11% vs 6%, P = .008). On multivariable analysis, independent predictors of conversion to open surgery were nighttime cholecystectomy, age, and gangrenous cholecystitis (P = .01). The only predictor of complications was gangrenous cholecystitis (P = .02).

      Conclusions

      Nighttime cholecystectomy is associated with an increased conversion to open surgery without decrease in length of stay or complications. These findings suggest that laparoscopic cholecystectomy for acute cholecystitis should be delayed until normal working hours.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ohta M.
        • Iwashita Y.
        • Yada K.
        • et al.
        Operative timing of laparoscopic cholecystectomy for acute cholecystitis in a Japanese institute.
        JSLS. 2012; 16: 65-70
        • Madan A.K.
        • Aliabadi-Wahle S.
        • Tesi D.
        • et al.
        How early is early laparoscopic treatment of acute cholecystitis?.
        Am J Surg. 2002; 183: 232-236
        • Koo K.P.
        • Thirlby R.C.
        Laparoscopic cholecystectomy in acute cholecystitis. What is the optimal timing for operation?.
        Arch Surg. 1996; 131 (discussion 544–5): 540-544
        • Asai K.
        • Watanabe M.
        • Kusachi S.
        • et al.
        Risk factors for conversion of laparoscopic cholecystectomy to open surgery associated with the severity characteristics according to the Tokyo guidelines.
        Surg Today. 2014; : 1-5
        • Gelbard R.
        • Karamanos E.
        • Teixeira P.G.
        • et al.
        Effect of delaying same-admission cholecystectomy on outcomes in patients with diabetes.
        Br J Surg. 2014; 101: 74-78
        • Phatak U.R.
        • Wray C.J.
        • Lew D.
        • et al.
        Night Time Is Not the Right Time: Increased Risk of Complications after Laparoscopic Cholecystectomy at Night.
        (May 17-21, 2013) Society for Surgery of the Alimentary Tract, Orlando, Florida2013
        • Yokoe M.
        • Takada T.
        • Strasberg S.M.
        • et al.
        TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos).
        J Hepatobiliary Pancreat Sci. 2013; 20: 35-46
        • Khwaja A.
        KDIGO clinical practice guidelines for acute kidney injury.
        Nephron Clin Pract. 2012; 120: 179-184
        • Brooks K.R.
        • Scarborough J.E.
        • Vaslef S.N.
        • et al.
        No need to wait: an analysis of the timing of cholecystectomy during admission for acute cholecystitis using the American College of Surgeons National Surgical Quality Improvement Program database.
        J Trauma Acute Care Surg. 2013; 74 (173–4): 167-173
        • Gurusamy K.S.
        • Davidson C.
        • Gluud C.
        • et al.
        Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis.
        Cochrane Database Syst Rev. 2013; 6: CD005440
        • Yamashita Y.
        • Takada T.
        • Strasberg S.M.
        • et al.
        TG13 surgical management of acute cholecystitis.
        J Hepatobiliary Pancreat Sci. 2013; 20: 89-96
        • Banz V.
        • Gsponer T.
        • Candinas D.
        • et al.
        Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy.
        Ann Surg. 2011; 254: 964-970
        • Stevens K.A.
        • Chi A.
        • Lucas L.C.
        • et al.
        Immediate laparoscopic cholecystectomy for acute cholecystitis: no need to wait.
        Am J Surg. 2006; 192: 756-761
        • Kelz R.R.
        • Freeman K.M.
        • Hosokawa P.W.
        • et al.
        Time of day is associated with postoperative morbidity: an analysis of the national surgical quality improvement program data.
        Ann Surg. 2008; 247: 544-552
        • Switzer J.A.
        • Bennett R.E.
        • Wright D.M.
        • et al.
        Surgical time of day does not affect outcome following hip fracture fixation.
        Geriatr Orthop Surg Rehabil. 2013; 4: 109-116
        • Orman E.S.
        • Hayashi P.H.
        • Dellon E.S.
        • et al.
        Impact of nighttime and weekend liver transplants on graft and patient outcomes.
        Liver Transpl. 2012; 18: 558-565
        • Yaghoubian A.
        • Kaji A.H.
        • Ishaque B.
        • et al.
        Acute care surgery performed by sleep deprived residents: are outcomes affected?.
        J Surg Res. 2010; 163: 192-196
        • Falor A.E.
        • Zobel M.
        • Kaji A.
        • et al.
        Admission variables predictive of gangrenous cholecystitis.
        Am Surg. 2012; 78: 1075-1078
        • Brodsky A.
        • Matter I.
        • Sabo E.
        • et al.
        Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted?.
        Surg Endosc. 2000; 14: 755-760
        • Rothschild J.M.
        • Keohane C.A.
        • Rogers S.
        • et al.
        Risks of complications by attending physicians after performing nighttime procedures.
        JAMA. 2009; 302: 1565-1572
        • Sturm L.
        • Dawson D.
        • Vaughan R.
        • et al.
        Effects of fatigue on surgeon performance and surgical outcomes: a systematic review.
        ANZ J Surg. 2011; 81: 502-509
        • Nurok M.
        • Czeisler C.A.
        • Lehmann L.S.
        Sleep deprivation, elective surgical procedures, and informed consent.
        N Engl J Med. 2010; 363: 2577-2579
        • Zahn R.
        • Schiele R.
        • Seidl K.
        • et al.
        Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction. Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Study Group.
        Am Heart J. 1999; 138: 1111-1117
        • Vinden C.
        • Nash D.M.
        • Rangrej J.
        • et al.
        Complications of daytime elective laparoscopic cholecystectomies performed by surgeons who operated the night before.
        JAMA. 2013; 310: 1837-1841