National Trends in Outcomes and Operative Approach After Non-Elective Cholecystectomy, 2015-2024.

BACKGROUND: Contemporary national trends in outcomes and operative approach after non-elective cholecystectomy remain incompletely characterized. We evaluated 10-year changes in short-term outcomes and operative approach. STUDY DESIGN: This retrospective cohort study identified 231,048 adults undergoing non-elective cholecystectomy in ACS-NSQIP from 2015-2024, excluding elective procedures, ASA class 5, and concurrent procedures. Poisson regression with robust variance evaluated temporal trends. Models adjusted for operative approach, ASA group, sex, age, BMI, Hispanic ethnicity, hypertension, diabetes, COPD, CHF, bleeding disorder, and operative time. RESULTS: Adjusted 30-day mortality decreased from 0.59% in 2015 to 0.38% in 2024 (34.8% relative decrease; P<0.001), reoperation from 1.54% to 1.14% (26.2%; P<0.001), and major complications from 6.77% to 5.41% (20.1%; P<0.001). Adjusted mean length of stay decreased from 3.71 to 2.97 days (19.9%; P<0.001). Minimally invasive surgery increased from 91.53% to 97.95%; robotic utilization increased from 1.78% in 2022 to 13.57% in 2024. Conversely, adjusted surgical-site infection increased from 1.68% to 3.52%, driven primarily by organ/space infection (1.02% to 2.59%; P<0.001). CONCLUSIONS: Nationally, non-elective cholecystectomy was associated with substantial reductions in adjusted mortality, reoperation, major complications, and length of stay from 2015-2024 as minimally invasive utilization increased. The concurrent rise in organ/space surgical-site infection identifies an important countervailing morbidity trend requiring further investigation.