Delayed Surgery Can Be Less Effective

Acute cholecystitis should be treated immediately by surgery new study reports

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Many people take measures to avoid surgery. Depending on the disease, however, surgery may be a treatment option that works better sooner rather than later. A recent study provided evidence on the benefits of pursuing surgery early for one of the most common diseases in the United States.

The study found that patients who received surgery shortly after being diagnosed with acute cholecystitis had better results than patients who waited. Patients who had surgery early tended to have fewer complications and were able to leave the hospital sooner than patients who waited.

Acute cholecystitis is a condition that occurs when gallstones cause a buildup of bile in the gallbladder, causing it to become irritated and possibly infected.

According to the authors of this study, there has been wide controversy about when surgery is the best treatment option for acute cholecystitis. This research may help patients and their doctors decide how soon to pursue surgery.

"Learn about your surgical options."

Markus Buchler, MD, PhD, Managing Director of Heidelberg University Hospital's Department of Surgery, and colleagues aimed to determine the advantages of treating acute cholecystitis with surgery soon after diagnosis rather than later.

Their study spanned four years in length and consisted of 618 participants who were divided into two groups. One group included 304 patients who were randomly assigned to surgery within 24 hours after being admitted to the hospital, while the other group included 314 patients who received an antibiotic treatment instead.

Patients who received antibiotic treatment had their surgery postponed for seven to 45 days. All of the patients had their infections treated with moxifloxacin for a minimum of 48 hours.

The state of each patient's health was documented up to 75 days after surgery.

The researchers found that 34.4 percent of patients who had postponed surgery had reports of complaints and complications, whereas only 11.8 percent of patients who had surgery shortly after being diagnosed had similar reports.

“Thus, regarding morbidity, it is statistically proven that immediate cholecystectomy (surgery) is superior to conservative treatment followed by delayed treatment,” Dr. Buchler and colleagues wrote.

The researchers further found that patients who underwent surgery early stayed in the hospital for an average 5.4 days after treatment, while patients who underwent surgery later stayed in the hospital an average 10 days after treatment.

A total of 58 harmful or undesirable events were reported by 43 patients who had undergone early surgery and 179 similar reports from 127 patients who had undergone surgery later.

The researchers reported that there were absolutely no advantages to delaying surgery with antibiotic treatment for patients with acute cholecystitis and recommend pursuing surgery immediately.

One limitation of this study was that it compared only two very different treatments for acute cholecystitis. Many of the patients who had their surgery delayed had to go in earlier than expected. Due to this, the researchers could not statistically prove the timing of their operations.

Despite these limitations, the researchers are confident in the findings of their study.

“Our results show that immediate cholecystectomy within 24 hours of hospital admission is the therapy of choice and should be implemented as treatment algorithm for this condition,” the researchers wrote.

This study was published online in September in the Annals of Surgery.

Dr. Buchler reported a grant for this study from Bayer Vital GmbH. Study co-authors Carsten N. Gutt, MD, and Jens Encke, MD, have received honoraria for lecturing, and Drs. Buchler, Encke and Gutt have received reimbursements for travel expenses from Bayer Vital GmbH. The other authors declared no conflicts of interest.

Review Date: 
September 18, 2013
Last Updated:
September 18, 2013