IMPACT OF DECISION-TO-OPERATING-ROOM DELAY ON SURGICAL OUTCOMES OF EARLY LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CALCULOUS CHOLECYSTITIS: A PROSPECTIVE ANALYTICAL STUDY

Abstract

Objective: To determine the impact of decision-to-operating-room (OR) delay (≤36 hours versus >36 hours) on total hospital length of stay, and to compare operative and postoperative outcomes, among adult patients undergoing early laparoscopic cholecystectomy for acute calculous cholecystitis. Study Design: Prospective, analytical (observational) study. Setting: Department of Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi. Period: November 2025 to February 2026. Material & Methods: Fifty adult patients with Tokyo Guidelines 2018-defined acute calculous cholecystitis, severity grade I or II, planned for early laparoscopic cholecystectomy within the index admission, were enrolled by non-probability purposive sampling (25 per delay category). Clinical decision time and operating-room entry time were recorded prospectively; their difference defined the decision-to-OR delay, dichotomised at 36 hours. Baseline, operative and 30-day outcomes were compared between groups using the independent-samples t test/Mann-Whitney U test, Chi-square/Fisher's exact test, Spearman correlation and multivariable linear regression, using SPSS version 26. Results: The ≤36-hour (n=25) and >36-hour (n=25) groups were comparable at baseline. Total hospital stay was significantly longer with prolonged delay (113.8±21.6 vs 78.9±16.0 hours; mean difference 34.9 hours, 95% CI 24.1-45.8; p<0.001), an association that remained significant after adjustment for age, Tokyo grade, symptom duration, diabetes and ASA class (42.4% longer stay, 95% CI 25.9-61.0%; p<0.001). Operative duration, Nassar operative difficulty grade, bailout procedures, conversion and complication rates did not differ significantly between groups. No readmission, reintervention or death occurred in either group. Conclusion: A decision-to-operating-room delay of more than 36 hours independently prolongs total hospital stay after early laparoscopic cholecystectomy for acute calculous cholecystitis, without measurably worsening operative difficulty or complication rates, supporting theatre-access prioritisation as a modifiable target for reducing bed occupancy.