Itaru Endo1, Tadahiro Takada2, Tsann-Long Hwang3, Kohei Akazawa4, Rintaro Mori5, Fumihiko Miura2, Masamichi Yokoe6, Takao Itoi7, Harumi Gomi8, Miin-Fu Chen3, Yi-Yin Jan3, Chen-Guo Ker9, Hsiu-Po Wang10, Seiki Kiriyama11, Keita Wada2, Hiroki Yamaue12, Masaru Miyazaki13, Masakazu Yamamoto14. 1. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. 2. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. 3. Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan. 4. Department of Medical Informatics, Niigata University, Niigata, Japan. 5. Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan. 6. Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan. 7. Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan. 8. Center for Global Health Mito Kyodo General Hospital University of Tsukuba, Ibaraki, Japan. 9. Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan. 10. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. 11. Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan. 12. Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan. 13. Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan. 14. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
BACKGROUND: Although early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities. METHODS: An international multicentric retrospective observational study was conducted over a 2-year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone. RESULTS: The subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index (CCI) scores below and above 6 (P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0-3 days after admission (P < 0.01). Multiple regression analysis revealed CCI and low body mass index <20 as predictive factors of 30-day mortality in Grade I+II patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30-day mortality in Grade III patients. In Grade III patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor. CONCLUSION: Even patients with Grade III severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder drainage may have a therapeutic role in subgroups with higher CCI or higher disease severity.
BACKGROUND: Although early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities. METHODS: An international multicentric retrospective observational study was conducted over a 2-year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone. RESULTS: The subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index (CCI) scores below and above 6 (P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0-3 days after admission (P < 0.01). Multiple regression analysis revealed CCI and low body mass index <20 as predictive factors of 30-day mortality in Grade I+II patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30-day mortality in Grade III patients. In Grade III patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor. CONCLUSION: Even patients with Grade III severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder drainage may have a therapeutic role in subgroups with higher CCI or higher disease severity.
Authors: Ana María González-Castillo; Juan Sancho-Insenser; Maite De Miguel-Palacio; Josep-Ricard Morera-Casaponsa; Estela Membrilla-Fernández; María-José Pons-Fragero; Miguel Pera-Román; Luis Grande-Posa Journal: World J Emerg Surg Date: 2021-05-11 Impact factor: 5.469
Authors: Christopher P Rice; Krishnamurthy B Vaishnavi; Celia Chao; Daniel Jupiter; August B Schaeffer; Whitney R Jenson; Lance W Griffin; William J Mileski Journal: World J Gastroenterol Date: 2019-12-28 Impact factor: 5.742