The structure of care for Emergency General Surgery (EGS) practices varies widely across hospital settings. EGS practices outside the setting of acute care surgery (ACS) services are less well understood. Within a multi-hospital setting, an innovative MIS-focused EGS practice was created to improve surgeon satisfaction, patient outcomes, and patient retention. We report successful implementation and expansion of an MIS EGS service across three hospital settings. Retrospective analysis of cases between January 2023 and December 2025 by a group of EGS surgeons across three hospitals using data available from the electronic medical record. Clinic volumes were identified for 2024/2025. Information on case volumes and types (elective vs. non-elective status, case type, OR block time) and clinic volumes and type of clinic visits were reported. Over the 36-month period, 10,228 surgical cases were performed, the majority non-elective. A total of 8.4 FTE surgeons staffed three hospital EGS services, a total of four surgeons with clinical responsibilities Monday–Friday and two surgeons with clinical responsibilities on nights and weekends. Half-day clinics were staffed by surgeons for a total of 3.5 days per week across two sites with > 5000 clinic visits per year. 17.2

BACKGROUND:Smoking cessation is associated with decreased morbidity and mortality as well as perioperative risk reduction. We aimed to explore video-based telehealth counseling as a potential avenue for smoking cessation. The purpose of this study was to determine rates of patient engagement in a video-based virtual point-of-care tobacco cessation program across varied general surgery clinics. METHODS:This study implemented a workflow that engaged active smokers in surgery clinics with a video-based tobacco cessation program. The program included intake by a tobacco specialist nurse and longitudinal support by an advanced practice provider. Patient engagement and participation rates were evaluated across all steps in the cessation process. RESULTS:Three clinics implemented the tobacco cessation program over a 3-19-month period. Of the 702 patients who attended the clinic visit, 10.3% were referred to an advanced practice provider, and 5.4% attended at least 1 advanced practice provider visit. There were no significant differences in participation between races; however, White patients constituted sequentially higher proportions of patients in each progressive step. Upon further analysis, patients with hernias and gastrointestinal disease diagnoses were more likely to schedule and attend a smoking cessation session. DISCUSSION:Implementation of a virtual tobacco cessation program resulted in low engagement and behavior change. Although our goal was to leverage virtual care to provide resources not otherwise available in these general surgery clinics, the intervention may not have been aligned well with the patient population we were attempting to reach. Further studies are needed to understand the optimal engagement time, patient populations, and methods for the general surgery patient population.

INTRODUCTION:Each year, millions of people experience recurrent diverticulitis episodes. Elective sigmoid colon resection reduces the risk of recurrence, but The American Society of Colon and Rectal Surgeons recommends individualising surgical decisions based on the impact of the condition on a patient's quality of life (QoL). However, no threshold for QoL impairment has been established to guide decision-making, and evidence comparing elective colectomy with medical management in terms of QoL limitation is limited. To address these gaps and to guide treatment decision-making, we designed the Comparison of Surgery and Medicine on the Impact of Diverticulitis (COSMID) trial.The COSMID trial is a large, pragmatic randomised trial including patients with QoL-limiting diverticulitis that aims to determine if partial colectomy is superior to medical management and explore subgroups that are more likely to respond to each treatment. METHODS AND ANALYSIS:COSMID will recruit 250 English-speaking and Spanish-speaking adults with imaging-confirmed and QoL-limiting diverticulitis (defined using a modified diverticulitis-related QoL survey). Participants are randomly assigned to undergo elective partial colectomy or receive comprehensive medical management (eg, selected from options including fibre, probiotics, mesalamine and rifaximin). A total of 100 patients who decline randomisation but consent to follow-up will be included in a parallel observational cohort. The primary outcome is the time-averaged score of the Gastrointestinal Quality of Life Index at 6, 9 and 12 months after randomisation. Secondary outcomes include clinical adverse events, healthcare utilisation, recurrent episodes of diverticulitis and additional patient-reported outcomes like the Diverticulitis Quality of Life instrument, decisional regret and work productivity. Exploratory analyses aim to identify differential treatment effects based on patients' characteristics. ETHICS AND DISSEMINATION:This trial was approved by the Vanderbilt Institutional Review Board (IRB) on 26 August 2019 (IRB #191217). Vanderbilt serves as the institutional review board of record for the following study sites: Albany Medical College, Allegheny Health, Atrium Health Carolinas Medical Center, Virginia Mason Medical Center, Boston University Medical Center, Cedars-Sinai Medical Center, UT Health Lyndon B. Johnson Hospital, Medical University of South Carolina, New York-Presbyterian Queens, Stanford University, University of Pennsylvania, University of California San Diego, University of California San Francisco, University of Colorado Denver, University of Florida, University of Iowa, University of Utah, University of Washington Medical Center, University of South Florida, University of Rochester Medical Center, University of Texas Southwestern Medical Center, Virginia Commonwealth University, Lahey Hospital & Medical Center, Weill Cornell Medical Center and Northwell Health. Rush University Medical Center (approved 8 January 2020), Columbia University Medical Center (approved 28 January 2020), Northwestern University (approved 19 March 2020), Mount Carmel Health System (approved 5 May 2020) and Memorial Health University Medical Center (approved 4 April 2022) are regulated and were approved by their respective IRBs. Results from this trial will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER:NCT04095663.

BACKGROUND:Small bowel obstruction (SBO) is a common emergency general surgery condition frequently initially managed nonoperatively, although the optimal duration of nonoperative management (NOM) before operative intervention remains uncertain. We evaluated national variation in NOM duration and its association with clinical outcomes and healthcare use. STUDY DESIGN:We performed a retrospective cohort study using the American College of Surgeons NSQIP Emergency General Surgery Targeted Database (June 2022-December 2024). Adults with SBO who underwent an initial trial of NOM followed by surgery were included. Patients were stratified by quartiles of NOM duration after excluding high-duration outliers. Multivariable regression adjusted for demographics, comorbidities, and disease severity. A sensitivity analysis was performed in patients with adhesive SBO. RESULTS:Among 8,993 patients with SBO, 70.0% underwent initial NOM, and 1,865 ultimately required surgery. Mean NOM duration was 3.3 ± 2.4 days. Baseline demographic characteristics were similar across quartiles. Longer NOM duration was independently associated with increased postoperative and total length of stay (both p<0.001), with a significant linear trend across quartiles. After adjustment, 30-day morbidity, mortality, and readmission did not differ by NOM duration. Findings were consistent in the adhesive SBO sensitivity analysis. CONCLUSIONS:National variation in NOM duration for SBO is substantial. Among patients ultimately requiring operative intervention, prolonged NOM was associated with increased healthcare utilization without measurable improvement in short-term postoperative outcomes, supporting efforts to optimize and standardize time-limited nonoperative management.

BackgroundTransfer of low-risk emergency general surgery (EGS) patients from a Level I Trauma tertiary care hospital and free-standing emergency department (FS-ED) to an affiliated community hospital saves tertiary care bed days and operating room (OR) time. Patient experience with this process is unknown. The study aims to evaluate the experience and satisfaction during their surgical care episode of transferred low-risk EGS patients.MethodsEGS patients undergoing non-elective laparoscopic cholecystectomy or appendectomy were prospectively identified between May 2023 and March 2024. Patients were divided into groups based on initial assessment location and transfer status: (1) no transfer; (2) tertiary care-ED to community hospital; and (3) FS-ED to community hospital. Data collected included demographics, ED length of stay (ED-LOS), OR characteristics, and 30-day outcomes. Post-discharge, patients were surveyed on safety perceptions, satisfaction, and overall experience using five-point Likert scales and open-ended questions. Responses were analyzed using univariate and thematic analysis.ResultsOf 216 patients identified, 69 participated in the post-discharge survey (32%). There were no significant differences in baseline characteristics and 30-day outcomes between groups, except for hospital LOS (P < 0.01). Most transferred patients were satisfied with the transfer process (84% from FS-ED; 75% from tertiary care hospital). There were no significant differences in information clarity and feelings of preparedness and safety at discharge by discharge location.ConclusionsTransfer of appropriate patients improves capacity and resources at tertiary care hospitals without decreasing patient satisfaction or increasing safety concerns. Standardized education on the transfer process is likely to positively impact patient experience.

Objective:. This study provides an up-to-date diagnosis framework for the study of emergency general surgery (EGS) patients. A final list of International Classification of Diseases, Tenth Revision (ICD-10) codes was the main outcome for the study. Codes were compared with the number codes generated by MapIT alone. Background:. Since transition to ICD-10, a Delphi process to define EGS diagnoses, as originally described for the ICD, Ninth Revision (ICD-9) codeset, has not been performed. Automated mapping software (MapIT) has been utilized, with a few studies verifying the translation. Methods:. Using previously defined ICD-9 EGS codes, MapIT was used to identify ICD-10 EGS codes. Review of adjacent codes in a Delphi process resulted in a finalized list of ICD-10 codes. Delphi and MapIT codes were quantified in the Nationwide Inpatient Sample to compare rates to the ICD-9 era. Results:. MapIT identified 935 ICD-10 codes from 485 ICD-9 codes. Manual review identified an additional 1907 adjacent codes. In total, after the modified Delphi process, 1579 (55.6%) of manually and MapIT-identified codes were included in the final codeset. After initial mapping, 880 (55.7%) of the final codes did not automatically map through the software. MapIT codes resulted in a significantly decreased number of patient encounters in the Nationwide Inpatient Sample compared with Delphi codes in the ICD-10 era. Conclusions:. The Delphi-created ICD-10 EGS codeset provides a more robust, accurate translation of the ICD-9 codes than MapIT software. This codeset can be used to inform EGS research to study and improve EGS patients’ care.

BACKGROUND:Shared decision-making is integral to patient-centered, goal concordant health care. In this model clinicians and patients work together to make care plans balancing clinical evidence regarding risks, benefits, and expected outcomes with patient preferences and values. While this is an ideal approach to patient care shared decision-making is inconsistently applied. Our aim was to identify surgery attendings', fellows', and residents' perceived barriers to, comfort with, and training experience in shared decision-making. METHODS:Surgery attendings (attendings/fellows) and residents across a health care market were surveyed regarding perceived barriers towards performing shared decision-making (August-October 2023). Provider demographics, perceived patient/family and time barriers, as well as surgeon comfort in utilizing shared decision-making were queried using a 5-point Likert scale. The survey was administered via REDCap and results were compared between resident and attending (fellow/attending) physicians. Univariate analysis was used to compare the difference between groups. RESULTS:Over the survey period 40 residents and 44 attendings responded (53% response). Residents were more likely to have had prior shared decision-making simulation-based education (P = .002). Significant barriers to residents using shared decision-making included lack of time (P = .01) and the fear of being perceived as being less knowledgeable when discussing different treatment options (P < .0001) compared to attending physicians. Residents were less comfortable in discussing "Big Picture" prognosis (P < .0001), addressing unrealistic patient/family expectations (P = .01), and clarifying patient preferences (P = .04) compared with attendings. CONCLUSION:While multiple barriers to shared decision-making were identified, the greatest need for further training was noted in the resident responses. Future training for residents should focus on the identified barriers toward implementing shared decision-making.

BACKGROUND:Recent studies have suggested that surgeon years of experience are associated with postoperative outcomes for emergency general surgery (EGS) patients and that there may be a benefit to obtaining input from colleagues in high-risk EGS cases. We aimed to assess current EGS practices regarding obtaining a second opinion for emergency cases and barriers to doing so across an acute care surgery network. METHODS:Surgeons providing EGS coverage across a cohort of hospitals comprising an acute care surgery network were queried in this original research survey study. Survey questions targeted surgeon perception of factors related to increased mortality and current practice regarding barriers to obtaining input from a colleague. RESULTS:Forty-eight surgeons responded to the survey (80%). Surgeons perceived patient age 70 years or older and American Society of Anesthesiologists score ≥3 to be the highest risk factors for mortality. Surgeons reported that, in 23% of cases, they obtained input from a colleague most commonly because of case complexity. About a third of the time input impacted the decision to operate or operative approach. The most significant barrier to obtaining input from a colleague was the time of day/night. CONCLUSIONS:Obtaining input from a surgical colleague is not uncommon in current practice and often impacts the care plan. The most significant barrier to obtaining colleague input may potentially be overcome by creating a cohort of trusted surgeons within a health system who are available for consultation at all times of day and night. Future studies to elucidate how to identify trusted surgeons and the impact of such a structure on patient outcomes are needed. LEVEL OF EVIDENCE:Therapeutic/Care Management; Level IV.

INTRODUCTION:Smoking is associated with increased postoperative complications. Our aim was to evaluate implementation of a virtual tobacco cessation program in two regional general surgery clinics and discern provider and staff perspectives on program barriers and facilitators. METHODS:A tobacco treatment registered nurse (TTRN) worked with surgery clinics to create and implement a workflow to engage active smokers in a tobacco cessation program. The program included initial registered nurse intake and referral to Advanced Practice Providers for longitudinal support. Patient engagement across iterations of the program was evaluated, and qualitative evaluation was conducted through focus groups with clinic staff and provider interviews. RESULTS:The tobacco cessation program was implemented in 3 clinics over 3-19 mo. Patient engagement was higher when the workflow did not rely on clinic staff - either when the TTRN was in-person or when the TTRN made post-visit phone calls. Immediate availability of the TTRN was a strong asset, while patient resistance and work processes were barriers. CONCLUSIONS:Implementation of a virtual TTRN in general surgery clinics yielded low patient engagement in tobacco cessation efforts. Even with workflow-conscious design, additional steps for clinic staff were a barrier and with limited patient acceptance it was not feasible to sustain or consider expanding. Further understanding of the optimal time and method for engaging patients in preoperative smoking cessation is needed.

Background: Ventral hernia repair (VHR) is one of the most commonly performed procedures by surgeons; however, there remains a lack of consensus for key components of operative reporting. Prior literature has identified several key elements that are recommended for inclusion in ventral hernia repair operative notes, but it is unclear whether these details alone make for a high-quality operative note. This study sought to determine whether experts agree on what factors make a ventral hernia repair operative note high-quality. Study Design: A prospective exploratory sequential survey-based mixed-methods design was used for round 1. Conclusions via thematic analysis from survey responses were used to establish themes/subthemes to be included in a high-quality ventral hernia repair operative note. Round 2 used a convergent design and sought to evaluate the importance of these identified themes/subthemes. Results: Twenty-four surgeons were approached, 16 of whom completed both rounds. Nine themes and 3 subthemes were identified as essential for inclusion in a high-quality ventral hernia repair operative note. Round 2 determined that the 5 most important themes to include are accurate/adequate/pertinent details, clarity in writing, detailed/specific/comprehensive information, objective reporting of findings and procedures, and justification/rationale for decisions.Conclusion: Based on expert consensus, this study suggests that high-quality operative notes require more than just detailed information. Instead, they must incorporate qualities spanning the 9 identified themes to ensure clarity, comprehensiveness, and effectiveness. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

The benefits of minimally invasive approaches-such as laparoscopy, both standard and with the robotic platform, and therapeutic endoscopy-have been adopted in many settings across emergency general surgery (EGS). Due to the breadth of EGS, the benefits of minimally invasive approaches are highlighted for specific disease processes within this text. In addition to disease-specific review, the interplay between patient physiology and minimally invasive approaches and the importance of quality as these frontiers continue to advance are discussed.

Background: Freestanding emergency departments have risen in popularity as a means to expand access to care. Although some evaluation of freestanding emergency department utility in specific patient populations exists, management of surgical patients via remote triage and disposition has not been previously described. We report our experience with remote triage to discharge home, level I trauma center, or community hospital admission for general surgery patients who present to an affiliated freestanding emergency department. Methods: A retrospective cohort study of patients presenting to freestanding emergency departments requiring surgical consultation between 2016 and 2021 was conducted. Outcomes included disposition, length of stay, surgical intervention, 30 -day mortality, and readmission. Undertriage and overtriage rates were calculated and defined as the following: (1) discharge undertriageddischarge home with 30 -day emergency department visit/readmission; 2) transfer undertriagedtransfers to community hospital requiring transfer to trauma center; and (3) overtriagedadmissions <24 hours without surgery. Results: Of 1,105 patients, 15% were discharged home, 27% were transferred to trauma centers, and 58% were transferred to community hospitals. Patients admitted to trauma centers were older and had higher acuity pathology, whereas patients admitted to community hospitals had higher operative rates with shorter lengths of stay, operating room time, 30 -day readmission, and mortality. Transfer undertriage was 0.9% (n = 6), with only 1 patient requiring transfer from a community hospital to a trauma center for disease acuity. Discharge undertriage was 12% (n = 20) due to worsening or persistent pathology. Overtriage was 5.5% (n = 52), with most having a partial small bowel obstruction or ambiguous diagnostic imaging requiring observation. Conclusion: Remote surgery triage at freestanding emergency departments, without an in -person examination, demonstrated both low undertriage and overtriage rates, reflecting appropriate triage practices. (c) 2023 Elsevier Inc. All rights reserved.

OBJECTIVE:Since introducing new and alternative treatment options may increase decisional conflict, we aimed to describe the use of the decision support tool (DST) and its impact on treatment preference and decisional conflict. BACKGROUND:For the treatment of appendicitis, antibiotics are an effective alternative to appendectomy, with both approaches associated with a different set of risks (eg, recurrence vs surgical complications) and benefits (eg, more rapid return to work vs decreased chance of readmission). Patients often have limited knowledge of these treatment options, and DSTs that include video-based educational materials and questions to elicit patient preferences about outcomes may be helpful. Concurrent with the Comparing Outcomes of Drugs and Appendectomy trials, our group developed a DST for appendicitis treatment ( www.appyornot.org ). METHODS:A retrospective cohort including people who self-reported current appendicitis and used the AppyOrNot DST between 2021 and 2023. Treatment preferences before and after the use of the DST, demographic information, and Ottawa Decisional Conflict Scale (DCS) were reported after completing the DST. RESULTS:A total of 8243 people from 66 countries and all 50 U.S. states accessed the DST. Before the DST, 14% had a strong preference for antibiotics and 31% for appendectomy, with 55% undecided. After using the DST, the proportion in the undecided category decreased to 49% ( P < 0.0001). Of those who completed the Ottawa Decisional Conflict Score (DCS; n = 356), 52% reported the lowest level of decisional conflict (<25) after using the DST; 43% had a DCS score of 25 to 50, 5.1% had a DCS score of >50 and 2.5% had and DCS score of >75. CONCLUSIONS:The publicly available DST appyornot.org reduced the proportion that was undecided about which treatment they favored and had a modest influence on those with strong treatment preferences. Decisional conflict was not common after use. The use of this DST is now a component of a nationwide implementation program aimed at improving the way surgeons share information about appendicitis treatment options. If its use can be successfully implemented, this may be a model for improving communication about treatment for patients experiencing emergency health conditions.

Objective: Ventriculoperitoneal (VP) shunt placement requires a concurrent abdominal procedure. For peritoneal access laparoscopic or open approach may be utilized. Our aim was to compare patient/procedure characteristics and outcomes by peritoneal approach for VP shunts in children.Methods: NSQIP-Pediatric procedure targeted cerebral spinal fluid shunt Participant Use Data Files from 2016 to 2020 were queried. Patients were grouped into laparoscopic vs open abdominal approach. Patient demographics, procedure characteristics and 30-day outcomes were compared.Results: 7742 NSQIP-Pediatric patients underwent VP shunt placement. Patients undergoing laparoscopic approach were older and required less preoperative support. Mean operative time was longer with laparoscopy (mean(SD): 74.2(48.1) vs. 64.6(39) minutes, p < 0.0001) but had shorter hospital LOS. There was no difference in SSI, readmissions, or reoperation rates.Conclusion: Patients undergoing laparoscopy for distal VP shunts are older with less support needs preoperatively. While laparoscopic approach had a shorter hospital LOS, there was no demonstratable difference in SSI, readmissions or reoperations between approaches. Further studies are needed to assess long-term outcomes.

Introduction Emergency General Surgery (EGS) represent a wide spectrum of diseases with high complication and mortality rates. Race, insurance, and socioeconomic status have been associated with mortality in EGS patients. Acute care surgery (ACS) models have previously shown improved outcomes for EGS patients. We hypothesized that transition to an ACS model would increase access to care for underserved and higher risk EGS patients in a community hospital, without a change in mortality. Methods This retrospective cohort study included adult EGS patients from 2017 to 2021 with current procedural terminology (CPT) codes of colectomy, small-bowel resection, peptic-ulcer surgery, appendectomy, or cholecystectomy. In July 2020, the hospital transitioned from a traditional model to an ACS model. Patients were analyzed for 42-month before (pre-ACS) and 18-month after (post-ACS) transition. Primary outcome was mortality; secondary outcomes were 30-day postoperative emergency department visits and readmission. Results We analyzed 467 pre-ACS and 238 post-ACS patients. After transition, patients were more likely to be Black, older, self-pay, and have higher Elixhauser Comorbidity Index (ECI) scores. Rates of cholecystectomies increased and appendectomies decreased after transition. Adjusting for age, race, and ECI, there were no changes in 30-day all-cause mortality (0.9% versus 2.1%, P = 0.63), length of stay (2.7-days versus 3-days, P = 0.91) and rate of postop emergency department visits (7.5% versus 11.3%, P = 0.16). There was a significant increase in hospital readmission after the ACS transition (5.1 versus 10.5%, P = 0.001, odds ratio 5.3). Conclusions After implementation of an ACS model, we found an increase in EGS patients who were older, Black, underinsured, with higher ECI without change in mortality. Implementation of ACS models at community hospitals may increase access to quality care for underserved and higher risk patient populations.

IntroductionPayment structured around Episodes of Care is a method for incentivizing decreased care utilization after major procedures. We examined Major Bowel Episodes of Care (MB-EoC)—the focus among general surgery procedures—within a large health system to determine the contribution of emergency bowel surgery to higher costs of care.MethodsAdult MB-EoC cases from July 2018 to June 2021 were reviewed for 90-d costs, examining patient age, insurance, diagnosis, cost of care, and contributors to cost. For patients aged ≥45 y who had nonelective care for colon cancer, incidence of prior screening colonoscopy was examined.ResultsWe identified 1292 colectomy cases. Mean age was 65 y. Of these patients, 90% had Medicare/commercial insurance. Colon cancer comprised 41% of primary diagnoses. Twenty-eight percent of cases were nonelective, more likely to have Medicaid/underinsured (21% versus 7%, P < 0.001), and had higher utilization of postdischarge cost-drivers. Ninety-day EoC per case cost was 66% higher for emergent versus elective cases. Of eligible emergency cancer cases, 43% (40/93) had undergone prior colonoscopy within 10 y. For patients with colon cancer, 90-d EoC per case was 39% higher for emergent versus elective cases.ConclusionsEmergency MB-EoC cases disproportionally contribute to higher 90-d care utilization and costs. Efforts to increase screening colonoscopy in appropriate populations may have a substantial impact on MB-EoC costs.

BACKGROUND:Smoking is associated with increased postoperative complications. Pre-surgical smoking cessation remains a challenge. Our aim was to summarize pre-hospital smoking cessation interventions and impact on smoking cessation rates. METHODS:Independent review of English language articles identified from systematic searches of MEDLINE, PubMed, PsycInfo, Embase, Web of Science, and Cumulative Index to Nursing & Allied Health Literature databases from 1998 to 2019 was performed (PROSPERO registration number CRD42021247927). Studies of adult patients enrolled in a pre-hospital smoking cessation intervention were included. Studies with historical controls or only self-reported outcomes were excluded. RESULTS:Nine articles including 1762 patients were identified. Exhaled CO was used to confirm cessation. Six studies reported smoking status day of surgery. Interventions included NRT, hand-held technology, e-cigarettes, decision aids/counseling and medications. Four studies demonstrated a difference in smoking cessation rates. Ethics and study appraisal were assessed using ROB2. CONCLUSIONS:Based on the variability of interventions, settings, and outcomes, best practice for successful pre-hospital smoking cessation in surgery clinics would benefit from ongoing investigation.

Background Patients with acute cholecystitis (AC) presenting with unfavorable systemic or local conditions are often managed with percutaneous cholecystostomy (PC) as a temporary measure. The clinical outcomes of interval cholecystectomy following PC remain unclear. The aim of the study was to identify the association between the timing of cholecystectomy following PC for AC and perioperative complication rates at interval cholecystectomy. We hypothesized that there would be a specific time interval to cholecystectomy associated with lower risk for adverse events. Methods This was a retrospective (2018-2020) multicenter study at 8 participating hospital systems of adult patients with AC, managed with PC and interval cholecystectomy. Demographics, comorbidities, treatment details, and outcomes were examined. Patients were grouped based on quartiles for timing of surgery after PC (< 7, 7-9, 10-13, > 13 weeks). The primary outcome was a composite endpoint of bile duct injury, reoperation, readmission, image-guided intervention, endoscopic intervention, conversion to open surgery, or death. Results There were 188 patients with a median age of 66 years with AC classified as mild (41%), moderate (47%), and severe (12%). Median days from PC to surgery were 65 (Q1 = 48, Q3 = 91). Laparoscopic cholecystectomy (89.9%) was the most commonly planned approach (robotic 6.4%, 3.7% open) and 28 (14.9%) were converted to open. The composite endpoint was reported in 51 patients (27.1%). A biliary injury occurred in 7 (3.7%) patients. Time to surgery and intraoperative drain placement were independently associated with the composite outcome. Cholecystectomy within 7 weeks of PC was associated with decreased risk (OR = 0.36, 95% CI 0.13-0.97) of the composite endpoint, compared to patients undergoing surgery > 13 weeks after PC. Conclusion Timing of surgery following PC was associated with procedural outcomes. Patients undergoing surgery before 7 weeks experienced significantly less morbidity than patients having delayed cholecystectomy. These results should be considered in patient selection and management after PC.