Early cholecystectomy for recurrent versus first-time cholecystitis: nationwide population-based study

TL;DR

A nationwide study in Sweden found that early surgery for recurring gallbladder inflammation leads to more complications than first-time surgery.

Contribution

This study is the first to show that recurrent cholecystitis surgeries have higher complication risks than first-time procedures using nationwide population data.

Findings

Recurrent cholecystitis patients had a 20.2% complication rate versus 13.8% for first-time cases.

Recurrent cases had higher odds of bile duct injury, intestinal perforation, and open surgery conversion.

Early surgery during the first episode is advised to avoid complications from recurrence.

Abstract

Acute cholecystitis is a common complication of gallstone disease. Although early laparoscopic cholecystectomy is recommended, some patients do not undergo early surgery and remain at risk of recurrent disease. This study investigated whether early cholecystectomy for recurrent cholecystitis is associated with higher complication rates versus first-time cholecystitis.

A retrospective population-based cohort study was conducted using data from the Swedish Registry of Gallstone Surgery. Patients undergoing early cholecystectomy for acute cholecystitis in Sweden between 1 January 2006, and 31 December 2020, were included. Patients with recurrent cholecystitis were compared to those with a first episode. The primary outcome was the total 30-day complication rate. Secondary outcomes included open surgery, prolonged surgery (≥ 120 minutes), bile duct injury, and specific complications such as intestinal injury, bleeding, reoperation, abscess, and 30-day mortality. Multivariable logistic regression was used to calculate odds ratios (OR), adjusting for age, sex, American Society of Anesthesiologists (ASA) grade, and time from admission to surgery as confounders.

Among 34 925 patients, 3384 had recurrent cholecystitis and 31 541 had first-time cholecystitis. The recurrent cholecystitis group had a higher complication rate (20.2 versus 13.8%) and an increased risk of bile duct injury (OR 2.44; 95% confidence interval (c.i.) 1.67 to 3.56), intestinal perforation (OR 2.54; 95% c.i. 1.51 to 4.25), prolonged surgery (OR 1.64; 95% c.i. 1.53 to 1.67), and open surgery (OR 1.76; 95% c.i. 1.64 to 1.92). However, patients with recurrent cholecystitis were older and had a higher ASA grade.

Early cholecystectomy for recurrent cholecystitis is associated with increased complication rates compared with first-time cholecystitis. These findings support early surgical intervention during the first episode to reduce the risk of adverse outcomes associated with recurrent disease.

This population-based cohort study from Sweden found that patients undergoing early cholecystectomy for recurrent cholecystitis had higher rates of complications than those operated on during their first episode. Those with recurrent cholecystitis had increased risks of bile duct injury, intestinal perforation, prolonged surgery, and conversion to an open procedure. The findings support early surgical intervention during the initial episode to reduce the risk of adverse outcomes associated with recurrence.

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