Laparoscopic Cholecystectomy is Safe Both Day and Night

Abstract

Background: It is reported that performing laparoscopic cholecystectomy (LC) at night leads to increased rates of complications and conversion to open. We hypothesize that it is safe to perform LC at night in appropriately selected patients.

Materials and methods: We performed a retrospective review of nonelective LC in adults at our institution performed between April 2007 and February 2015. We dichotomized the cases to either day or night.

Results: Five thousand two hundred four patients underwent LC, with 4628 during the day and 576 at night. There were no differences in age, body mass index, American Society of Anesthesiologists class, race, insurance type, pregnancy rate, or white blood cell count. There were also no differences in the prevalence of hypertension, diabetes, or renal failure. However, daytime patients had higher median initial total bilirubin (0.6 [0.4, 1.3] versus 0.5 [0.3, 1.0] mg/dL, P = 0.002) and lipase (33 [24, 56] versus 30 [22, 42] U/L, P < 0.001) values. There was no difference in case length, estimated blood loss, rate of conversion to open, biliary complications, length of stay (LOS) after operation, unanticipated return to the hospital in 60 d, or 60-d mortality. Daytime patients spent more time in the hospital with longer median LOS before surgery (1 [1, 2] versus 1 [0, 2] d, P < 0.001) and median total LOS (3 [2, 4] versus 2 [1, 3] d, P < 0.001) compared with night patients.

Conclusions: At our institution, we perform LC safely during day or night. The lack of complications and shorter LOS justify performing LC at any hour.

Keywords: Acute care surgery; Complications; Emergency general surgery; Laparoscopic cholecystectomy; Night; Safety.