Urgent cholecystectomy: safer overall, but organ-space infection has doubled

Design

Retrospective cohort, national registry (ACS-NSQIP)

Population

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

Primary outcome

30-day mortality, complications and surgical-site infection trends

Effect

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

A retrospective analysis of ACS-NSQIP (Journal of the American College of Surgeons, 28 September 2026) covered 231,048 adults having non-elective cholecystectomy from 2015 to 2024.

After adjustment, 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 most of a day. Minimally invasive surgery rose to 98%, and robotic use from 1.8% in 2022 to 13.6% in 2024. Against that, surgical-site infection rose from 1.68% to 3.52%, driven by organ-space infection (1.02% to 2.59%).

The infection rise is unexplained by this data set. Possible reasons include changing case mix, more subtotal cholecystectomy, coding change, or approach, and the study cannot separate them. It is worth auditing locally rather than assuming the improving headline figures cover every outcome.

• Audit organ-space infection after urgent cholecystectomy in your own unit
• Consider intra-abdominal collection early in a patient who is slow to recover after urgent cholecystectomy
• Record bile spillage, stone loss and subtotal technique, which may help explain local infection rates
• Do not read falling mortality as proof every complication is falling

Why it matters

It shows a complication moving the wrong way under an otherwise reassuring trend.

Don't overread it

Registry trends cannot say what caused the infection rise, including whether robotic use played any part.

The statistics, in plain English

These are adjusted rates over time from a registry; tiny P values here reflect the huge sample, not necessarily a large effect. The absolute rise in organ-space infection is about 1.6 percentage points - small for any one patient, meaningful across a busy unit.

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