BACKGROUND: Current treatment options for acute calculous cholecystitis include either early cholecystectomy, or conservative treatment consisting of intravenous antibiotics and an interval cholecystectomy several weeks later. Percutaneous drainage is reserved for patients in whom conservative therapy failed or as a salvage procedure for high risk patients. OBJECTIVE: To identify clinical and radiographic factors leading to failure of conservative treatment. METHODS: We prospectively collected data on consecutive patients admitted with the diagnosis of acute cholecystitis. Parameters were compared between patients who were successfully treated conservatively and those who required percutaneous cholecystostomy. Logistic regression analysis was performed to identify predictors for failure of conservative treatment. RESULTS: The study population comprised 103 patients with a median age of 60 who were treated for acute cholecystitis. Twenty-seven patients (26.2%) required PC. On univariate analysis, age above 70 years, diabetes, elevated white blood cell count, tachycardia (> 100 beats/min) at admission, and a distended gallbladder (> 5 cm transverse diameter) were found to be significantly more common in the PC group (P < 0.001). WBC was higher in the PC group throughout the initial 48 hours. On multivariate analysis, age above 70 (odds ratio 3.6), diabetes (OR 9.4), tachycardia at admission (OR 5.6), and a distended gallbladder (OR 8.5) were predictors for cholecystostomy (P < 0.001). Age above 70 (OR 5.2) and WBC $15,000 (OR 13.7) were predictors for failure of conservative treatment after 24 and 48 hours (P < 0.001). CONCLUSIONS: Age above 70, diabetes, and a distended gallbladder are predictors for failure of conservative treatment and such patients should be considered for early cholecystostomy. Persistently elevated WBC (> 15,000) suggests refractory disease and should play a central role in the clinical follow-up and decision-making process for elderly patients with acute cholecystitis.
BACKGROUND: Current treatment options for acute calculous cholecystitis include either early cholecystectomy, or conservative treatment consisting of intravenous antibiotics and an interval cholecystectomy several weeks later. Percutaneous drainage is reserved for patients in whom conservative therapy failed or as a salvage procedure for high risk patients. OBJECTIVE: To identify clinical and radiographic factors leading to failure of conservative treatment. METHODS: We prospectively collected data on consecutive patients admitted with the diagnosis of acute cholecystitis. Parameters were compared between patients who were successfully treated conservatively and those who required percutaneous cholecystostomy. Logistic regression analysis was performed to identify predictors for failure of conservative treatment. RESULTS: The study population comprised 103 patients with a median age of 60 who were treated for acute cholecystitis. Twenty-seven patients (26.2%) required PC. On univariate analysis, age above 70 years, diabetes, elevated white blood cell count, tachycardia (> 100 beats/min) at admission, and a distended gallbladder (> 5 cm transverse diameter) were found to be significantly more common in the PC group (P < 0.001). WBC was higher in the PC group throughout the initial 48 hours. On multivariate analysis, age above 70 (odds ratio 3.6), diabetes (OR 9.4), tachycardia at admission (OR 5.6), and a distended gallbladder (OR 8.5) were predictors for cholecystostomy (P < 0.001). Age above 70 (OR 5.2) and WBC $15,000 (OR 13.7) were predictors for failure of conservative treatment after 24 and 48 hours (P < 0.001). CONCLUSIONS: Age above 70, diabetes, and a distended gallbladder are predictors for failure of conservative treatment and such patients should be considered for early cholecystostomy. Persistently elevated WBC (> 15,000) suggests refractory disease and should play a central role in the clinical follow-up and decision-making process for elderly patients with acute cholecystitis.
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Authors: Itamar Feldman; Lena Feldman; Dvorah S Shapiro; Gabriel Munter; Amos M Yinnon; Reuven Friedman Journal: Isr J Health Policy Res Date: 2020-08-03
Authors: Michele Pisano; Niccolò Allievi; Kurinchi Gurusamy; Giuseppe Borzellino; Stefania Cimbanassi; Djamila Boerna; Federico Coccolini; Andrea Tufo; Marcello Di Martino; Jeffrey Leung; Massimo Sartelli; Marco Ceresoli; Ronald V Maier; Elia Poiasina; Nicola De Angelis; Stefano Magnone; Paola Fugazzola; Ciro Paolillo; Raul Coimbra; Salomone Di Saverio; Belinda De Simone; Dieter G Weber; Boris E Sakakushev; Alessandro Lucianetti; Andrew W Kirkpatrick; Gustavo P Fraga; Imitaz Wani; Walter L Biffl; Osvaldo Chiara; Fikri Abu-Zidan; Ernest E Moore; Ari Leppäniemi; Yoram Kluger; Fausto Catena; Luca Ansaloni Journal: World J Emerg Surg Date: 2020-11-05 Impact factor: 5.469