Predictive Factors for a Long Postoperative Stay after Emergency Laparoscopic Cholecystectomy Using the 2013 Tokyo Guidelines: A Retrospective Study.

Koichi Inukai

doi:10.1155/2019/3942584

Abstract

Laparoscopic cholecystectomy (LC) is widely used for treating early acute cholecystitis (AC) and substantially reduces hospital costs. This study aimed to identify and evaluate risk factors associated with long postoperative hospital stays (PHSs) in patients undergoing emergency LC for AC according to the 2013 Tokyo Guidelines (TG13). Clinical data of patients who underwent emergency LC for AC between 2011 and 2017 were retrospectively collected. Patients were divided into early discharge (ED, discharge in three days or less postoperatively) and late discharge (LD, discharge in more than three days postoperatively) groups based on clinical progression and PHS after LC. Preoperative characteristics and perioperative outcomes were analysed as potential risk factors for LD. Among 149 patients, 104 (69.8%) were discharged within 3 days postoperatively, whereas 45 (30.2%) had long PHSs. Main causes of LD were fever and inflammation. Univariate analysis of preoperative risk factors revealed significant differences in age, white blood cell count, C-reactive protein, total bilirubin (T-bil), and alkaline phosphatase (ALP) levels; anticoagulation therapy; and TG13 severity grade. Multivariate analysis revealed that TG13 severity grade II, age >65 years, and elevated T-bil and ALP levels are independent factors for long PHS. Older age, worse biliary function, and increased TG13 severity grade might predict prolonged PHSs in AC patients undergoing emergency LC.

Highlights

The safety and efficacy of laparoscopic cholecystectomy (LC), which has been increasingly adopted as a standard treatment approach [1], have been confirmed by numerous studies [2,3,4]
Information is limited on specific factors affecting the length of postoperative hospital stays (PHS) associated with cholecystectomy for acute cholecystitis (AC)
No studies have analysed long PHSs in patients undergoing emergency LC for AC according to the 2013 Tokyo Guidelines (TG13) [7]

Summary

Introduction

The safety and efficacy of laparoscopic cholecystectomy (LC), which has been increasingly adopted as a standard treatment approach [1], have been confirmed by numerous studies [2,3,4]. LC is recognised as a cost-effective treatment for patients with acute cholecystitis (AC) [4,5,6]. Zacks et al [5] reported that LC significantly reduced hospital costs as well as length of stay and mortality compared with open procedures. Information is limited on specific factors affecting the length of postoperative hospital stays (PHS) associated with cholecystectomy for AC. No studies have analysed long PHSs in patients undergoing emergency LC for AC according to the 2013 Tokyo Guidelines (TG13) [7]

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Conclusion