Emergency cholecystectomy is safer, but organ-space infection is rising

Design

Retrospective cohort, ACS-NSQIP registry trend analysis

Population

231,048 adults having non-elective cholecystectomy, 2015-2024

Primary outcome

30-day mortality, reoperation, major complications, infection

Effect

Mortality 0.59% to 0.38%; organ-space infection 1.02% to 2.59%

This retrospective cohort used ACS-NSQIP data on 231,048 adults having non-elective cholecystectomy in the US from 2015 to 2024, with trends adjusted for age, comorbidity, ASA grade, operative approach and operative 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%. Length of stay fell by about three-quarters of a day. Minimally invasive surgery rose to about 98%, and robotic use from 1.8% in 2022 to 13.6% in 2024. Against that, adjusted surgical-site infection doubled from 1.68% to 3.52%, driven by organ-space infection rising from 1.02% to 2.59%.

The cause is not established. Possibilities include more subtotal cholecystectomies leaving a stump, shorter stays moving infections into the community where they are coded differently, or changes in antibiotic practice. Any unit doing emergency cholecystectomy should look at its own organ-space infection rate rather than assume the overall improvement applies to every outcome.

• Audit organ-space infection after emergency cholecystectomy separately from superficial wound infection.
• Consider a collection on imaging in any patient with fever or rising inflammatory markers after early discharge.
• Give clear return advice on discharge: fever, right upper quadrant pain or vomiting.
• Note bile spillage, stone loss and subtotal technique in the operation note for later review.

Why it matters

A falling mortality rate can hide a rising complication that now presents after the patient has gone home.

Don't overread it

This is registry trend data; it cannot show what caused the rise in organ-space infection.

The statistics, in plain English

Adjusted rates account for changes in patient mix over time, so the trends are not simply due to sicker or healthier patients. Absolute rates remain low: organ-space infection still affects about 1 in 40 patients.

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