Nighttime cholecystectomy is associated with an increased conversion to open surgery without decrease in length of stay or complications. These findings suggest that laparoscopic cholecystectomy for acute cholecystitis should be delayed until normal working hours.

1. Dr Arjun Rajagopalan
BIOPSY

2. We know …
• Current recommendation for patients
presenting with acute cholecystitis is
cholecystectomy in the same hospitalisation.
• Some centres perform the operation as an
urgent procedure, at night times if needed.
We don’t know …
• Night time cholecystectomy leads to a
shortening of the time to surgery but may be
accompanied by increased complications.
Dr Arjun Rajagopalan
BIOPSY

3. 1: Population
Patients who had undergone laparoscopic
cholecystectomy for acute cholecystitis.
• Night time cholecystectomy: 7 pm to 7 am.
• Day time cholecystectomy: 7 am to 7 pm.
Timing of
cholecystectomy
907 233
Night time
Day time
Dr Arjun Rajagopalan
BIOPSY

4. 3: Outcome variable 2: Indicator variable
Night time cholecystectomy
4: Comparison
Day time cholecystectomy
Dr Arjun Rajagopalan
BIOPSY
Complications
Conversion to open
2.75% 5.5% 8.25% 11%
6%
7%
11%
5%
Night time
Day time
p = 0.5
p = 0.008
Outcomes Night time (233) Day time (907) p’
TIme to surgery (days) 1.5 2.0 < 0.001
Operating time (mts) 110.5 92.4 < 0.001
Length of stay (days) 1.6 1.2 0.08

5. The author(s) conclude …
Night time cholecystectomy is
associated with an increased
conversion to open surgery
without decrease in length of stay
or complications. These findings
suggest that laparoscopic
cholecystectomy for acute
cholecystitis should be delayed
until normal working hours.
Dr Arjun Rajagopalan
BIOPSY

6. METHODOLOGY
Type of study Observational
SAMPLING
Centre Teaching hospital, USA
TIme frame 1 Jan 2011- 1 Aug 2013
Analysis Retrospective
A priori sample
size calculation
-
Exclusions
CBD stones, gallstone
pancreatitis, previous
cholecystostomy
Numbers
1140 patients
Night time group - 233
Day time group - 907
COMPARISON
Controls Yes
Randomization ⛔ ️
Protocols/ training ⛔ ️
Comparability of groups ASA IV - more in day time
MEASUREMENT
Training -
Blinding -
Multiple observers -
Duplication -
BIOPSY The author(s) conclude …
Night time cholecystectomy is
associated with an increased
conversion to open surgery
without decrease in length of stay
or complications. These findings
suggest that laparoscopic
cholecystectomy for acute
cholecystitis should be delayed
until normal working hours.
Dr Arjun Rajagopalan