E. S. Tseng1, J. Imran1, J. Byrd1, I. Nassour1, S. S. Luk1, M. Choti1, M. Cripps1 1University Of Texas Southwestern Medical Center,Dallas, TX, USA
Introduction: The acute care surgical model has increased the ability to perform non-elective laparoscopic cholecystectomies (LC) during day and night hours. Despite the potential to reduce hospital length of stay (LOS) and improve operating room usage, it is reported that performing LC at night leads to increased rates of complications and conversion to open. We hypothesize that it is safe to perform LC at night in appropriately selected patients.
Methods: We performed a retrospective review of over 5200 non-elective LC in adults at a large urban tertiary referral hospital performed between April 2007 and February 2015. We dichotomized the cases to either day (case started between 7am-6:59pm) or night (case started between 7pm-6:59am). Univariate analysis was performed using Mann-Whitney U, chi-squared, and Fisher's exact tests.
Results: A total of 5206 patients underwent LC, with 4628 during the day and 576 at night. There was no difference in age; body mass index (BMI); ASA class; race; insurance type; pregnancy rate; history of hypertension, diabetes, or renal failure; or white blood cell count. However, patients who underwent LC during the day were more likely to have presented with obstructive biliary complications of cholelithiasis as evidenced by higher median total bilirubin (0.6 [0.4, 1.3] vs. 0.5 [0.3, 1.0] mg/dL, p = 0.002) and lipase (33 [24, 56] vs. 30 [22, 42] U/L, p < 0.001). Operatively, there was no difference in case length, estimated blood loss, rate of conversion to open, biliary complications, LOS after operation, unanticipated return to the hospital in 60 days, or 60-day mortality. There were significant differences in median LOS before surgery (1 [1, 2] vs. 1 [0, 2] days, p < 0.001) and median total LOS (3 [2, 4] vs. 2 [1, 3] days, p < 0.001) with day patients spending more time in the hospital compared to night patients. Logistic regression to look at the effects of ASA class, total bilirubin, lipase, BMI, and day vs. night status on the likelihood of biliary complications showed that none of the factors had statistical significance.
Conclusion: In this center with an acute care surgery service, it is safe to perform LC during day or night. The lack of complications and shorter LOS justifies performing LC at any hour.