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Patients with symptomatic gallstones face a rapidly rising risk of complex gallbladder surgery when treatment is postponed beyond the first 48 hours after pain begins.
Gallstone disease continues to place considerable pressure on surgical services in Ecuador, particularly when delayed care leads to worsening inflammation and technically difficult procedures. While surgeons commonly rely on the Parkland Grading Scale (PGS) to measure operative severity, limited evidence exists on how healthcare delays and patient-related factors jointly affect surgical outcomes in local clinical settings.
The investigation aimed to determine whether demographic characteristics, symptom duration, and healthcare system barriers were associated with increased surgical severity among individuals treated with laparoscopic cholecystectomy. The team performed a retrospective cross-sectional analysis of 259 patients aged over 15 years who underwent laparoscopic gallbladder removal at a tertiary-level hospital. Operative severity was categorized using the PGS, with grades 3 to 5 considered severe presentations. They evaluated patient-specific variables such as age, sex, and duration of abdominal pain, together with system-related factors including recurrent biliary colic episodes. Statistical assessment was conducted using generalized linear Poisson models to calculate adjusted prevalence ratios, while Restricted Cubic Spline analysis explored changes in risk according to pain duration.
The study found that surgical severity increased significantly with delayed treatment, especially after the first 48 hours of symptom onset. Severe gallbladder disease was identified in 31.7% of patients. Recurrent biliary colic emerged as an important risk factor, doubling the likelihood of severe disease. A higher risk of severe surgical presentation was observed among men and older patients. Further analysis demonstrated that the risk of severe disease increased progressively with delayed presentation after symptom onset, as shown in Table 1.
The findings indicated that delayed access to surgery and unresolved recurrent biliary symptoms substantially increased the likelihood of difficult gallbladder operations. Early surgical intervention during the initial 48-hour period appeared critical for limiting disease progression and reducing operative challenges.
Surgical Endoscopy
The 48-h window of opportunity: patient and health system-related predictors of surgical severity in symptomatic cholelithiasis
Doris Sarmiento-Altamirano et al.
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