Most Gallbladder Surgery Can Wait Until Morning

Dennis Kim, MD Los Angeles Biomedical Research Institute Researcher Interview with:

Dennis Kim, MD
Los Angeles Biomedical Research Institute Researcher

Medical Research: What are the main findings of the study?

Dr. Kim: Laparoscopic cholecystectomy, a minimally invasive procedure to remove the
gallbladder, is one of the most common abdominal surgeries in the U.S. Yet
medical centers around the country vary in their approaches to the procedure
with some moving patients quickly into surgery while others wait. Our study
found gallbladder removal surgery can wait until regular working hours
rather than rushing the patients into the operating room at night.

The gallbladder is a pear-shaped organ on the upper right side of the
abdomen that collects and stores bile, a digestive fluid produced by the
liver. Gallbladders may need to be removed from patients who suffer pain
from gallstones that block the flow of bile.

In a laparoscopic cholecystectomy, surgeons insert a tiny video camera and
special surgical tools through small incisions in the abdomen to remove the
gallbladder. Occasionally, surgeons may need to create a large incision to
remove the gallbladder, and this is known as an open cholecystectomy.

We conducted a retrospective study of 1,140 patients at two large urban
referral centers who underwent gallbladder removal surgeries. We found 11%
of the surgical procedures performed at night (7 a.m.-7 p.m.) were converted
to the more invasive procedure, open cholecystectomies. Only 6% of those who
underwent the surgery during the day required the more invasive form of

Medical Research: What was most surprising about the results?

Dr. Kim: We had expected to find that gallbladder removal surgeries performed at
night (7 p.m. to 7 a.m.) would be associated with decreased lengths of stay.
Instead we found nighttime surgeries did not affect overall length of stay.
Patients whose gallbladders were removed at night stayed an average of 3.7
days, while those who underwent the surgeries in the day stayed an average
of 3.8 days.

Medical Research: What should clinicians and patients take away from your report?

Dr. Kim: Despite evidence supporting the benefit of timely laparoscopic
cholecystectomy for acute cholecystitis, any benefits of shortened time to
operation by performing cholecystectomy after hours were outweighed by the
increased conversion rate. In conclusion, these findings suggest
laparoscopic cholecystectomy for acute cholecystitis should be delayed until
regular daytime hours.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Kim: With more detailed medical records, future research could track the
post-surgical complication rate. In this study, the complication rates were
difficult to measure because of the lack of follow-up records for the
patients after they left the hospital.

Can it wait until morning? A comparison of nighttime versus daytime
cholecystectomy for acute cholecystitis

James X. Wu, Andrew T. Nguyen, Christian de Virgilio, David S. Plurad, Amy H. Kaji, Virginia Nguyen, Edward Gifford, Michael de Virgilio, Reed Ayabe, Darin Saltzman, Dennis Kim. Can it wait until morning? A comparison of nighttime versus daytime cholecystectomy for acute cholecystitis. The American Journal of Surgery, 2014; DOI: 10.1016/j.amjsurg.2014.09.004

Last Updated on September 26, 2014 by Marie Benz MD FAAD