Prediction of Surgical Difficulty in Laparoscopic Cholecystectomy for Acute Cholecystitis Performed Within 24 Hours After Hospital Admission

Abstract

The objective of this study was to identify preoperative factors predicting operative difficulty in patients who underwent laparoscopic cholecystectomy for acute cholecystitis within 24 hours after hospital admission. Many reports have described the superiority of performing laparoscopic cholecystectomy in the early phase of acute cholecystitis. Recently, even earlier cholecystectomy within 24 hours after hospital admission has been recommended. However, the factors that influence surgical difficulty in this patient population have not been well scrutinized. We analyzed patients who underwent laparoscopic cholecystectomy for acute cholecystitis within 24 hours of hospital presentation from 2007 to 2015. The primary outcome was the operation time. We also analyzed the amount of blood loss and the rate of conversion to open surgery. Seventy-three patients were enrolled. Mean age at surgery was 66 ± 16 years, and 52 patients were male. The mean operation time was 128 ± 59 minutes. Body mass index ≥25 kg/m2 [odds ratio (OR) = 3.6; 95% confidence interval (CI): 1.4–30.9] and dirty fat sign on preoperative computed tomography (OR = 5.3; 95% CI: 1.0–34.2) were significantly associated with increased operative time. Dirty fat sign was also significantly associated with increases in the amount of blood loss and conversion rate. Surgery should be performed more carefully in patients with these risk factors in laparoscopic cholecystectomy for acute cholecystitis performed within 24 hours of hospital presentation.