Choosing Wisely:

Don’t discharge patients presenting emergently with acute cholecystitis without first offering laparoscopic cholecystectomy.

Rationale and Comments: Surgeons often debate the timing of cholecystectomy in patients with acute cholecystitis. Evidence suggests that cholecystectomy during the index hospitalization is both safe and cost-effective. Interval cholecystectomy may be associated with higher chance of requiring open surgery or readmission, increasing costs. Finally, patients with acute cholecystitis who are discharged without undergoing surgery may have a higher risk of presenting with complications of cholelithiasis, which can be more morbid than the initial presentation.
Sponsoring Organizations:
  • Society of American Gastrointestinal and Endoscopic Surgeons
  • Sources:
  • Society of American Gastrointestinal and Endoscopic Surgeons guideline
  • Disciplines:
  • Surgical
  • References: • SAGES guideline for the clinical application of laparoscopic biliary tract surgery. Available at https://www.sages.org/publications/guidelines/guidelines-for-the-clinical-application-of-laparoscopic-biliarytract-surgery/.
    • Cheruvu, CVN, Eyre-Brook, IA, 2002. Consequences of prolonged wait before gallbladder surgery. Annals of the Royal College of Surgeons of England, 84(1), pp.20–22.
    • de Mestral, C. et al., 2013. A population-based analysis of the clinical course of 10,304 patients with acute cholecystitis, discharged without cholecystectomy. The journal of trauma and acute care surgery, 74(1), pp.26–30– discussion 30–1.
    • de Mestral C, Hoch JS, Laupacis A, et al. Early Cholecystectomy for Acute Cholecystitis Offers the Best Outcomes at the Least Cost: A Model-Based Cost-Utility Analysis. J Am Coll Surg. 2016;222(2):185-194.

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