Wu James X, Nguyen Andrew T, de Virgilio Christian, Plurad David S, Kaji Amy H, Nguyen Virginia, Gifford Edward, de Virgilio Michael, Ayabe Reed, Saltzman Darin, Kim Dennis
Department of Surgery, Olive View - UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Department of Surgery, Harbor - UCLA Medical Center, 1000 W. Carson St., Torrance, CA, USA.
Am J Surg. 2014 Dec;208(6):911-8; discussion 917-8. doi: 10.1016/j.amjsurg.2014.09.004. Epub 2014 Sep 22.
The urgency of laparoscopic cholecystectomy for acute cholecystitis is under debate. We hypothesized that nighttime cholecystectomy is associated with decreased length of stay.
Retrospective review of 1,140 patients at 2 large urban referral centers with acute cholecystitis who underwent daytime (7 am to 7 pm) versus nighttime (7 pm to 7 am) cholecystectomy was conducted.
Nighttime cholecystectomy did not affect the overall length of stay (3.7 vs 3.8 days, P = .08) or complication rate (5% vs 7%, P = .5) versus daytime cholecystectomy. Nighttime cholecystectomy was associated with a higher conversion rate to open cholecystectomy (11% vs 6%, P = .008). On multivariable analysis, independent predictors of conversion to open surgery were nighttime cholecystectomy, age, and gangrenous cholecystitis (P = .01). The only predictor of complications was gangrenous cholecystitis (P = .02).
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.
急性胆囊炎行腹腔镜胆囊切除术的紧迫性存在争议。我们推测夜间胆囊切除术与住院时间缩短有关。
对两家大型城市转诊中心1140例急性胆囊炎患者进行回顾性研究，这些患者分别接受了日间（上午7点至晚上7点）和夜间（晚上7点至上午7点）胆囊切除术。
与日间胆囊切除术相比，夜间胆囊切除术对总体住院时间（3.7天对3.8天，P = 0.08）或并发症发生率（5%对7%，P = 0.5）无影响。夜间胆囊切除术与开腹胆囊切除术的转化率较高相关（11%对6%，P = 0.008）。多变量分析显示，转为开腹手术的独立预测因素为夜间胆囊切除术、年龄和坏疽性胆囊炎（P = 0.01）。并发症的唯一预测因素是坏疽性胆囊炎（P = 0.02）。
夜间胆囊切除术与开腹手术转化率增加相关，且住院时间和并发症并未减少。这些发现表明，急性胆囊炎的腹腔镜胆囊切除术应推迟至正常工作时间进行。
