Mortality risk estimation in acute calculous cholecystitis : beyond the Tokyo Guidelines
González-Castillo, Ana María (Institut Hospital del Mar d'Investigacions Mèdiques)
Sancho Insenser, Joan Josep (Institut Hospital del Mar d'Investigacions Mèdiques)
de Miguel-Palacio, Maite (Institut Hospital del Mar d'Investigacions Mèdiques)
Morera-Casaponsa, Josep-Ricard (Universitat Autònoma de Barcelona)
Membrilla Fernández, Estela (Institut Hospital del Mar d'Investigacions Mèdiques)
Pons-Fragero, María-José (Institut Hospital del Mar d'Investigacions Mèdiques)
Pera, Miguel (Institut Hospital del Mar d'Investigacions Mèdiques)
Grande, L (Institut Hospital del Mar d'Investigacions Mèdiques)
Universitat Autònoma de Barcelona

Date:	2021
Abstract:	Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. The overall mortality was 3. 6%. Mortality was associated with older age (68 IQR 27 vs. 83 IQR 5. 5; P = 0. 001) and higher Charlson Comorbidity Index (3. 5 5. 3 vs. 02; P = 0. 001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4. 66 95% CI 1. 7-12. 8 P = 0. 001), dementia (OR 4. 12; 95% CI 1. 34-12. 7, P = 0. 001), age 80 years (OR 1. 12: 95% CI 1. 02-1. 21, P = 0. 001) and the need of preoperative vasoactive amines (OR 9. 9: 95% CI 3. 5-28. 3, P = 0. 001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0. 003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26. 2% vs. 10. 5%). Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. Retrospectively registered and recorded in Clinical Trials.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Acute cholecystitis ; Acute calculous cholecystitis ; Early cholecystectomy ; High-risk patient ; Delayed cholecystectomy ; Percutaneous cholecystostomy ; Non-surgical treatment ; Mortality ; Tokyo Guidelines ; Charlson Comorbidity Index
Published in:	World Journal of Emergency Surgery : WJES, Vol. 16 (may 2021) , ISSN 1749-7922

DOI: 10.1186/s13017-021-00368-x
PMID: 33975601

10 p, 1.1 MB

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