Impact of surgical timing on postoperative quality of life in acute cholecystitis: a comparative analysis of early, intermediate, and delayed laparoscopic cholecystectomy

Abstract

Background: Acute cholecystitis, primarily caused by gallstones, is a serious condition that may lead to severe complications. The optimal timing of surgery for acute cholecystitis is still under debate. Early cholecystectomy is generally preferred to prevent complications and improve postoperative outcomes. This study aimed to evaluate the impact of early, intermediate, and delayed laparoscopic cholecystectomy on postoperative quality of life (QoL) in patients with acute cholecystitis.

Methods: This retrospective study included 201 patients who underwent laparoscopic cholecystectomy for acute cholecystitis between May 2019 and February 2023. Patients were categorized into three groups based on the timing of surgery: early (within one week), intermediate (1-6 weeks), and delayed (after six weeks). The Gastrointestinal Quality of Life Index (GIQLI) was used to evaluate QoL six months postoperatively. Data on patient demographics, surgery timing, and cholecystitis severity (based on the Tokyo Guidelines) were analyzed using univariate and multivariate regression models.

Results: The mean age of patients was 56.0 ± 14.9 years, and 65.7% were female. Early cholecystectomy was performed in 30.8% of cases, intermediate in 16.9%, and delayed in 52.2%. The median GIQLI score was 116. Patients who underwent early surgery had significantly higher GIQLI scores compared to those in the intermediate group (p < 0.001). No significant difference was observed between early and delayed surgery (p = 0.199). Multivariate analysis showed that intermediate surgery negatively affected QoL (p < 0.001), while cholecystitis severity was also a significant factor (p = 0.006).

Conclusions: Early laparoscopic cholecystectomy significantly improves postoperative QoL compared to intermediate surgery. Delayed surgery provides similar QoL outcomes to early surgery. However, intermediate cholecystectomy may lead to poorer QoL due to heightened surgical complexity and increased complications. Early intervention should be prioritized to optimize patient outcomes.

Keywords: Acute cholecystitis; Early intervention; Gastrointestinal quality of life ındex (GIQLI); Laparoscopic cholecystectomy; Postoperative quality of life; Surgical timing.