Key result
Out-of-hours urgent cholecystectomy was not associated with an increased risk of overall post-operative complications compared to in-hours operations (adjusted OR 1.04).
Why the study?
Does out-of-hours urgent cholecystectomy increase complications compared to in-hours urgent cholecystectomy in adults?
Meta-Analysis (n=194,135)
Does out-of-hours urgent cholecystectomy increase complications compared to in-hours urgent cholecystectomy in adults?
Odds Ratio: 1.04 (95% CI 0.9–1.19)
p-value: p=0.59
Out-of-hours urgent cholecystectomy is safe and not associated with an increased risk of complications compared to in-hours surgery.
Supports out-of-hours urgent cholecystectomy without excess overall complications; leaves open effects of acute surgical units on conversions.
Background Cholecystectomy is one of the most commonly performed abdominal operations. Demands on acute operating theatre availability have led to out-of-hours (evenings, nights, or weekend) cholecystectomy being performed, although it is not known whether outcomes differ between out-of-hours and in-hours (daytime on weekdays) cholecystectomy. Objective This systematic review and meta-analysis aimed to compare outcomes following out-of-hours versus in-hours urgent cholecystectomy. Methods MEDLINE, EMBASE and Scopus databases were systematically searched from inception to December 2020 for studies comparing outcomes from out-of-hours and in-hours urgent cholecystectomy in adults. The outcomes of interest were rates of bile leakage, bile duct injury (BDI), overall post-operative complications, conversion to open cholecystectomy, specific intra- and post-operative complications, length of stay (LOS), readmission and mortality. Sensitivity analysis of adjusted multivariate results was also performed. Results In total, 194,135 urgent cholecystectomies (30,001 out-of-hours; 164,134 in-hours) from 11 studies were included. Most studies were of high (64%) or medium (18%) quality. There were no differences between out-of-hours and in-hours cholecystectomy for rates of bile leakage, BDI, overall post-operative complications, conversion to open cholecystectomy, operative duration, readmission, mortality, and post-operative LOS. Higher rates of post-operative sepsis (odds ratio (OR) 1.58, 95% CI: 1.04-2.41; p=0.03) and pneumonia (OR 1.55, 95% CI: 1.06-2.26; p=0.02) were observed following out-of-hours cholecystectomy on univariate meta-analysis but not on adjusted multivariate meta-analysis. Conclusions There was no increased risk or difference in specific complications associated with out-of-hours compared with in-hours urgent cholecystectomy.
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Bhat et al. (2021) conducted a meta-analysis in Acute benign gallbladder disease (n=194,135). Out-of-hours urgent cholecystectomy vs. In-hours urgent cholecystectomy was evaluated on Overall post-operative complications (OR 1.04, 95% CI 0.90-1.19, p=0.59). Out-of-hours urgent cholecystectomy was not associated with an increased risk of overall post-operative complications compared to in-hours operations (adjusted OR 1.04).
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