Impact of Surgical Timing on Outcomes of Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis: A Multicenter Real-World Analysis.

Abstract

Background: Early laparoscopic cholecystectomy is recommended for acute calculous cholecystitis (ACC), although the optimal timing within the recommended early treatment window remains uncertain. This study evaluated whether different time intervals from symptom onset to surgery influence operative difficulty and perioperative outcomes in routine emergency surgical practice.

Methods: A retrospective multicenter study was conducted including consecutive patients who underwent LC for Tokyo Grade I or II ACC between January 2021 and December 2025. Patients were stratified according to Tokyo severity grade and further categorized into five predefined intervals according to time from symptom onset to surgery (≤6 hours, 6 to 12 hours, 12 to 24 hours, 24 to 72 hours, and > 72 hours). Demographic characteristics, comorbidities, operative findings, postoperative outcomes, and length of hospital stay were analyzed. Multivariable regression models were used to evaluate the independent association between surgical timing and perioperative outcomes after adjustment for relevant clinical confounders.

Results: A total of 306 patients were included, including 235 (76.8%) with Tokyo Grade I and 71 (23.2%) with Tokyo Grade II ACC. Delayed surgery was independently associated with greater intraoperative blood loss (adjusted mean ratio 1.29, 95% CI: 1.19 to 1.40; P < .001). In contrast, no independent association was observed between surgical timing and conversion to open surgery, overall postoperative complications, major complications (Clavien-Dindo grade ≥III), operative time, or length of hospital stay after multivariable adjustment. Although severe postoperative events were numerically more frequent in delayed subgroups, these differences were not statistically significant.

Conclusions: Within a real-world emergency surgery setting, surgical timing appears to influence technical complexity more than postoperative morbidity. Delayed intervention was associated with increased intraoperative blood loss but not with worse adjusted postoperative outcomes. These findings support an individualized, patient-tailored approach to early laparoscopic cholecystectomy rather than strict adherence to fixed temporal thresholds.