Under the headline "Best to take out gallbladder in daytime," MedPage Today reports on a study that says people who have laparoscopic cholecystectomies at night have more complications.
The work was presented at Digestive Disease Week in Orlando.
Ordinarily, I would not critique a paper that I had not read completely but I have to make an exception in this case.
There are some serious issues with both the research and the reporting. If the MedPage article is not read carefully, patients may receive inappropriate or delayed care.
According to the article, the paper comprised 549 patients who were mostly female (84%) with 65% having surgery in the daytime (defined as 7 a.m. to 7 p.m.), and 62% had surgery that was not elective—that is, urgent or emergent.
Those operated on at night had a longer median hospital length of stay, 3 days vs. 1 day and were more likely to have had non-elective surgery, p < 0.001 for both.
The article also says the nighttime patients "were more likely to have a discharge diagnosis." I'm only guessing, but I think they may have meant to say "a discharge diagnosis of acute cholecystitis."
"Bile leaks, bile duct injuries, retained stones, pneumonia, and readmission occurred at rates that did not differ significantly," says the report. The only complication that differed significantly was that of superficial wound infection, which occurred in 5% of the night and 2% of the day patients, p = 0.04.
Multivariate analysis showed that nighttime surgery increased the odds of complications by just over 3 times but with a wide confidence interval of 1.01-10.7 and a barely significant p value of 0.05.
So, what's the problem?
At the very end of the nearly 500-word article, we find that elective patients were excluded from the multivariate analysis with no explanation why. It could be that when the elective patients were included, there was no difference in outcomes.
The first part of the last sentence is even more revealing: "The authors also did not have data on postoperative length of stay and severity of gallbladder disease."
Perhaps some of the length of stay of 3 days for the nighttime patients was due to waiting for an available operating room, workup for possible common duct stones or stabilization of lab values.
But in my opinion, the factor that makes the entire study invalid is not knowing the severity of the gallbladder disease. A patient with a more severely inflamed gallbladder is obviously more likely to have a complication.
There is also no mention of co-morbidities like diabetes or heart disease which may have been more prevalent in the nighttime group.
I don't understand how this study ever saw the light of day, why it was selected as a featured paper by MedPage or why the misleading headline was used.
If you are a patient with a sick gallbladder, many recent studies have shown that you should have it removed as soon as possible—less time in the hospital, less cost better outcomes.
If your surgeon can do it at 8 p.m., please go ahead with the surgery. Don't wait until the next day.