Emergency cholecystectomy grew safer over a decade, but organ-space infection more than doubled

Design

Retrospective registry cohort (ACS-NSQIP), 2015–2024

Population

231,048 adults undergoing non-elective cholecystectomy

Primary outcome

Trends in 30-day mortality, complications and operative approach

Effect

Mortality 0.59% → 0.38%; major complications 6.77% → 5.41%; organ/space SSI 1.02% → 2.59%

Using the American College of Surgeons NSQIP registry, this study followed 231,048 adults who had a non-elective cholecystectomy between 2015 and 2024, adjusting for age, comorbidity, ASA grade, operative approach and operating time.

Adjusted 30-day mortality fell from 0.59% to 0.38%, reoperation from 1.54% to 1.14% and major complications from 6.77% to 5.41%, while mean stay shortened by about three-quarters of a day. Minimally invasive surgery rose to 98% of cases, and robotic use jumped from under 2% in 2022 to over 13% in 2024. Against that, adjusted surgical-site infection doubled from 1.68% to 3.52%, almost all of it organ/space infection, which rose from 1.02% to 2.59%.

The registry cannot say why organ/space infection rose. Changes in how it is recorded, more subtotal cholecystectomies with bile leaks and collections, earlier discharge with later presentation, and the spread of new techniques are all possible. It is a prompt to look at your own unit's data rather than a verdict on any technique. It was published on 28 September 2026.

• Audit your own organ/space infection and collection rate after emergency cholecystectomy.
• Consider whether rising subtotal cholecystectomy use in your unit is paired with drain and follow-up policies.
• Tell patients discharged early which symptoms of a collection should bring them back: fever, pain, jaundice.
• Record bailout procedures and post-discharge collections so they are counted, not lost to readmission elsewhere.
• Mortality and reoperation continue to fall; the concern is a specific infection trend.

Why it matters

A decade of better headline outcomes has hidden one morbidity moving the wrong way.

Don't overread it

A registry trend cannot show whether robotic or subtotal surgery caused the rise in infection.

The statistics, in plain English

These are adjusted rates, so changes in patient mix over the decade are partly accounted for. A 35% relative fall in mortality is a change from about 6 to 4 deaths per 1,000 operations. With over 200,000 cases, small changes are statistically certain; the question is whether they are real changes in care or in recording.

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