Outcomes of Laparoscopic Cholecystectomy Performed at Night

A Comparative Study with Daytime Surgery

Abstract

Background: Early laparoscopic cholecystectomy (LC) is recommended for acute cholecystitis, but the safety of nighttime LC has remained unclear. This study compared the perioperative outcomes of nighttime LC and daytime LC. Methods: We retrospectively reviewed 311 cases in which LC was performed within 72 hours of the onset of symptoms of acute cholecystitis between 2014 and 2024. Patients were categorized into a daytime group (09:00–17:00) and a nighttime group (17:00–09:00), and the perioperative outcomes, patient characteristics, and operator-related factors of the two groups were compared. Results: Of the 311 patients, 161 underwent daytime LC and 150 nighttime LC. There was significantly longer operative time (156.8 vs. 136.0 min), greater blood loss (132.8 vs. 76.8 mL), and a higher conversion rate (12% vs. 3.7%) in the nighttime group (all P< 0.01), but the difference in patients less suitable for an overnight delay complication rates (6.7% vs. 5.6%) was not significant. Conclusion: Nighttime LC was associated with greater blood loss, longer operative time, and a higher conversion rate, suggesting increased intraoperative difficulty and invasiveness, but there was no significant difference between the groups in postoperative morbidity. However, since these findings may have been influenced by the selective inclusion of patients less suitable for an overnight wait[delay] in the nighttime group, the results do not directly demonstrate the superiority or inferiority of nighttime surgery, but highlight the importance of triage-based case selection and institutional support.