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Acute Cholecystitis: Early Versus Delayed Cholecystectomy. A Multicenter Randomized Trial (ACDC Study, NCT00447304)
Carsten N Gutt*1, Jens Encke*2, Jörg Köninger*3, Julian C Harnoss*4, Karl Kipfmüller*5, Thorsten Götze*6, Markus T Golling*7, Ernst Klar*8, Katharina Feilhauer*3, Wolfram G Zoller*3, Karsten Ridwelski*9, Michael R Schön*10, Helmut K Seitz*11, Wolfgang Stremmel*4, Markus W Büchler4
1Memmingen Hospital, Memmingen, Germany2Johanna-Etienne-Hospital, Neuss, Germany3Katharinen Hospital, Stuttgart, Germany4University Hospital, Heidelberg, Germany5St. Marien Hospital, Muelheim, Germany6Ketteler Hospital, Offenbach, Germany7Diakonie Hospital, Schwaebisch Hall, Germany8University Hospital, Rostock, Germany9Magdeburg Hospital, Magdeburg, Germany10Karlsruhe Hospital, Karlsruhe, Germany11University Hospital Heidelberg, Heidelberg, Germany

OBJECTIVE(S): Acute cholecystitis is a common disease and laparoscopic surgery is the standard of care. There is insufficient evidence regarding the best time point for surgery (acute versus delayed).
METHODS: We conducted (2006-2011) a multicenter randomized trial to compare early (within 24 hours: ELC) versus delayed laparoscopic cholecystectomy (day 7-45: DLC). Primary endpoint was the overall morbidity within 75 days. Secondary endpoints were the surgical conversion rate, length of hospital stay, overall costs of treatment, mortality and change of antibiotic treatment.
RESULTS: 642 patients were screened and 618 patients were randomized, respectively (ELC 304, DLC 314). Overall morbidity within 75 days (primary endpoint) was 11.6% (ELC) and 31.3% (DLC), respectively (p<0.001). Mortality was one patient (0.3%) in each group. Conversion rates did not differ in early versus delayed cholecystectomy (ELC 9.9%, DLC 11.9%). The median length of hospital stay (ELC 5.4 days, DLC 10.0 days, p<0.001) and overall treatment cost were significantly different (ELC 2919€, DLC 4261€, p<0.001).
CONCLUSIONS: This is the largest ever conducted RCT in acute cholecystitis. Patients undergoing early laparoscopic cholecystectomy demonstrate considerably lower morbidity, shorter hospital stay and lower treatment costs. In acute cholecystitis early cholecystectomy should become the standard of treatment.
Outcome analysis
Primary endpointGroup ELC (N = 304)Group DLC (N = 314)p-value
Overall morbidity within 75 days (%)11.631.3<0.001
Secondary endpoints
Conversion rate to open surgery - no. (%)30 (9.9)33 (11.9)0.44
Adverse events - no. of patients (%)43 (14.1)127 (40.4)<0.001
Change of antibiotic treatment - no. (%)22 (7.2)31 (9.9)0.24
Mortality rate - no. (%)1 (0.3)1 (0.3)0.98
Total hospital stay - days, mean (interquartile range)5.4 (4-6)10.0 (7-12)<0.001
Duration of hospitalization after cholecystectomy - days, mean (interquartile range)4.68 (3-6)4.89 (3-6)0.07
Total hospital costs - Euro, mean (interquartile range)2919 (2651-2651)4261 (3021-4724)<0.001


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