Society of American Gastrointestinal and Endoscopic Surgeons

View all recommendations from this society

January 9, 2019

Don’t discharge patients presenting emergently with acute cholecystitis without first offering laparoscopic cholecystectomy.

Surgeons often debate the timing of cholecystectomy in patients with acute cholecystitis. Evidence suggests that cholecystectomy during the index hospitalization is both safe and cost effective. Interval cholecystectomy may be associated with higher chance of requiring open surgery or readmission, increasing costs. Finally, acute cholecystitis patients that are discharged without undergoing surgery may have a higher risk of presenting with complications of cholelithiasis, which can be more morbid than the initial presentation.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The SAGES Quality, Outcomes and Safety (QOS) Committee appointed a task force (comprised of active members of the committee) to develop a list of potential recommendations after being provided with information and links to the Choosing Wisely website. This group compiled a list of recommendations which fit the criteria outlined by the ABIM. A literature search was performed to ensure the recommendations were evidence-based. The task force then distributed the list to the full membership of the SAGES QOS Committee, asking the members of the committee to rank the recommendations by level of importance and clinical relevance. The top five recommendations were then selected for inclusion in this list.

Sources

SAGES guideline for the clinical application of laparoscopic biliary tract surgery. Available at https://www.sages.org/publications/guidelines/guidelines-for-the-clinical-application-of-laparoscopic-biliarytract-surgery/.

Cheruvu, C.V.N. & Eyre-Brook, I.A., 2002. Consequences of prolonged wait before gallbladder surgery. Annals of the Royal College of Surgeons of England, 84(1), pp.20–22.

de Mestral, C. et al., 2013. A population-based analysis of the clinical course of 10,304 patients with acute cholecystitis, discharged without cholecystectomy. The journal of trauma and acute care surgery,
74(1), pp.26–30– discussion 30–1.

de Mestral C, Hoch JS, Laupacis A, et al. Early Cholecystectomy for Acute Cholecystitis Offers the Best Outcomes at the Least Cost: A Model-Based Cost-Utility Analysis. J Am Coll Surg. 2016;222(2):185-
194.