Early vs. Interval Cholecystectomy for Acute Calculous Cholecystitis: A Prospective Observational Study in an Indian Adult Population

Background: Acute calculous cholecystitis is a common surgical condition for which the optimal timing of cholecystectomy remains clinically relevant.Early cholecystectomy provides definitive treatment during the index admission, whereas interval cholecystectomy follows initial conservative management.This study compared operative, postoperative, and hospitalization-related outcomes between early and interval cholecystectomy.Methods: A hospital-based prospective observational study was conducted among 100 patients aged 18-70 years with acute calculous cholecystitis at the Department of General Surgery, Narendra Modi Medical College and LG General Hospital, Ahmedabad, India, between February 2023 and March 2024.Only patients who ultimately underwent cholecystectomy were included.Patients were categorized according to the treating surgeon's clinical decision into early cholecystectomy, performed within 72 hours of diagnosis, or interval cholecystectomy following initial conservative management.Demographic characteristics, clinical and ultrasonographic findings, operative findings, conversion to open surgery, complications, additional interventions, operative duration, and hospital stay were assessed.Categorical and continuous variables were compared using appropriate statistical tests, with p < 0.05 considered statistically significant.Results: Of the 100 patients, 38 (38.0%) underwent early cholecystectomy, and 62 (62.0%) underwent interval cholecystectomy.Age and sex distributions were comparable between groups, whereas diabetes, inflammatory parameters, bilirubin levels, BMI, and several clinical manifestations differed significantly.Icterus, Murphy's sign, right hypochondrial lump, nausea/vomiting, and fever were significantly more frequent among patients undergoing early surgery.Conversion to open surgery occurred in 20/38 (52.6%) early and 14/62 (22.6%) interval cases (Pearson χ² = 9.481, p = 0.002).The unadjusted odds of conversion were higher in the early group (odds ratio = 3.81, 95% CI: 1.59-9.11).Nine bile duct injuries were verified through clinical record review and classified as Strasberg Type A (n = 5), Type B (n = 2), Type C (n = 1), and Type D (n = 1); all nine patients underwent endoscopic retrograde cholangiopancreatography with stent placement.Liver-bed bleeding and cystic artery bleeding were more frequent in converted procedures.Bile duct injury occurred in 5/38 (13.2%) early and 4/62 (6.5%) interval cases, without a statistically significant difference.Wound infection was most frequent in the early-converted group (9/20, 45.0%), compared with early-laparoscopic (2/18, 11.1%), interval-laparoscopic (1/48, 2.1%), and interval-converted procedures (3/14, 21.4%).Median total hospital stay was six days (interquartile range (IQR), 1) for early and seven days (IQR, 1) for interval surgery, while median postoperative stay was four and three days, respectively.Both differences were statistically significant (p < 0.001).Conclusion: Among patients who ultimately underwent cholecystectomy, early surgery was associated with higher unadjusted conversion odds and shorter recorded cumulative hospital stay.Baseline differences, surgeon-determined treatment allocation, and incomplete capture of outcomes during initial conservative management limit causal interpretation.The findings do not establish the comparative safety or effectiveness of the two strategies.