| Background According to the current guidelines,severity grading for acute calculous cholecystitis are Grade I(mild),Grade II(moderate),Grade III(severe).Laparoscopic Cholecystectomy(LC)is the gold standard treatment for acute calculous cholecystitis.However,there is still a great controversy about the timing of surgery for moderate acute calculous cholecystitis(MACC).The purpose of this study was to compare the outcomes of LC in MACC patients at different time intervals from admission to determine which is the better treatment strategy.Method A retrospective analysis of 157 patients with MACC according to the2018 Tokyo Guidelines(TG18)from November 2016 to October 2019.The included patients were classified into three groups according to the timing of surgery from admission: ?7 days(G1),>7 days(G2),at least 6 weeks after antibiotic treatment(G3).Primary outcome were conversion rate,perioperative complications,operative time,and postoperative length of stay.Secondary outcomes were total duration of antibiotic therapy,total length of hospital stay,total hospital costs,postoperative duration of antibiotic therapy,drainage tube removal time,and drainage tube placement rate.All statistical analyses were performed using SPSS 18.0 software.For continuous the normal data test was performed.Normal continuous variables were expressed as mean(standard deviation,SD),and compared using the the Student's t test or analysis of variance(ANOVA).Non-normal continuous variables were expressed as median(interquartile range,IQR),and compared using the Wilcoxon rank sum test or Kruskal-Wallis H test.Categorical variables are shown as frequencies and percentages,and were compared using the Chi-square test or Fisher's exact test. To assess the reasons for prolonged postoperative length of stay,multivariable Logistic regression analysis was performed and receiver operating characteristic(ROC)curves were generated.A P value <0.05 was considered significant.Results The included 157 patients were classified into the three groups,55 in G1,43 in G2,and 59 in G3.In the G3,3 patients were diagnosed with secondary choledocholithiasis on re-admission and ERCP+LC was performed.G2 had longer operative time(92 vs 110 vs 76 min,P<0.001).Conversion rate and postoperative complications were similar(3.6% vs 11.6% vs 6.8%,P=0.305)and(5.5% vs 9.3% vs8.5%,P=0.804),respectively.G1 had shorter total duration of antibiotic therapy(7 vs11 vs 9d,P<0.001),total length of hospital stay(8 vs 14 vs 15 d,P<0.001),total hospital costs(14654 vs 20431 vs 20801?,P<0.001).G3 had shorter postoperative duration of antibiotic therapy(3 vs 3 vs 2d,P<0.001)and postoperative length of stay(4 vs 4 vs 3d,P=0.016).Postoperative length of stay was different in the three groups,so we analyzed the factors that prolonged postoperative hospital stay.Age(OR=1.043,95%CI: 1.003-1.084,P=0.034),drainage tube removal time(OR=2.838,95%CI: 1.540-5.231,P=0.001),postoperative duration of antibiotic therapy(OR=2.953,95%CI:1.944-4.486,P<0.001)were independent factors for prolonged postoperative hospital stay.Age,drainage tube removal time and postoperative duration of antibiotic therapy had an area under the ROC curve(0.594,P=0.041;0.826,P<0.001;0.906,P<0.001).Conclusions(1)LC is safe and effective in patients with MACC who have been hospitalized for within 7 days and more than 7 days.And patients underwent LC within 7 days of admission has lower hospital costs.(2)Some patients has secondary choledocholithiasis during the waiting period,early surgery can reduce the incidence of secondary choledocholithiasis. (3)Age,drainage tube removal time,postoperative duration of antibiotic therapy were independent factors for prolonged postoperative hospital stay.Rational and appropriate use of antibiotics should be underscored. |
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