Masamichi Yokoe1, Tadahiro Takada2, Tsann-Long Hwang3, Itaru Endo4, Kohei Akazawa5, Fumihiko Miura2, Toshihiko Mayumi6, Rintaro Mori7, Miin-Fu Chen3, Yi-Yin Jan3, Chen-Guo Ker8, Hsiu-Po Wang9, Takao Itoi10, Harumi Gomi11, Seiki Kiriyama12, Keita Wada2, Hiroki Yamaue13, Masaru Miyazaki14, Masakazu Yamamoto15. 1. Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, 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 Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. 5. Department of Medical Informatics, Niigata University, Niigata, Japan. 6. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan. 7. Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan. 8. Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan. 9. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. 10. Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan. 11. Center for Global Health Mito Kyodo General Hospital University of Tsukuba, Ibaraki, Japan. 12. Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan. 13. Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. 14. Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan. 15. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
BACKGROUND: The collaborative multicenter retrospective study of acute cholecystitis (AC) was performed in Japan and Taiwan. The aim for this study was evaluation of the clinical value of TG13 severity grading for AC. METHOD: The study was designed as an international multicenter retrospective study of AC from 2011 to 2013. Based on the data, we investigated the TG13 severity grading by analyzing the correlations between grade and prognosis, surgical procedures, histopathology, and organ dysfunction and prognosis. RESULTS: An investigation revealed that 30-day overall mortality rate was 1.1% for Grade I, 0.8% for Grade II, 5.4% for Grade III. The mortality rate for Grade III was significantly higher than lower grades (P < 0.001). The greater the number of organ dysfunction, the higher the mortality rate (P < 0.001). However, the mortality rate varied depending on the number of organ dysfunction (3.1-25%). With respect to the surgical procedures, laparoscopic cholecystectomy was performed for Grade I patients (P < 0.001), and the higher the grade, the more likely open surgery would be selected (P < 0.001). CONCLUSION: TG13 severity grading criteria for AC are providing great benefits in actual clinical settings. From this study, the position of each severity grade was obviously confirmed.
BACKGROUND: The collaborative multicenter retrospective study of acute cholecystitis (AC) was performed in Japan and Taiwan. The aim for this study was evaluation of the clinical value of TG13 severity grading for AC. METHOD: The study was designed as an international multicenter retrospective study of AC from 2011 to 2013. Based on the data, we investigated the TG13 severity grading by analyzing the correlations between grade and prognosis, surgical procedures, histopathology, and organ dysfunction and prognosis. RESULTS: An investigation revealed that 30-day overall mortality rate was 1.1% for Grade I, 0.8% for Grade II, 5.4% for Grade III. The mortality rate for Grade III was significantly higher than lower grades (P < 0.001). The greater the number of organ dysfunction, the higher the mortality rate (P < 0.001). However, the mortality rate varied depending on the number of organ dysfunction (3.1-25%). With respect to the surgical procedures, laparoscopic cholecystectomy was performed for Grade I patients (P < 0.001), and the higher the grade, the more likely open surgery would be selected (P < 0.001). CONCLUSION: TG13 severity grading criteria for AC are providing great benefits in actual clinical settings. From this study, the position of each severity grade was obviously confirmed.
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