Matthew Hernandez1, Brittany Murphy2, Johnathan M Aho2, Nadeem N Haddad3, Humza Saleem2, Muhammad Zeb2, David S Morris4, Donald H Jenkins3, Martin Zielinski2. 1. Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: hernandez.matthew@mayo.edu. 2. Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA. 3. Division Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. 4. Division of General Surgery, Trauma, and Critical Care, Intermountain Medical Center, Murray, UT, USA.
Abstract
BACKGROUND: Acute cholecystitis presents with heterogeneous severity. The Tokyo Guidelines 2013 is a validated method to assess cholecystitis severity, but the variables are multifactorial. The American Association for the Surgery of Trauma (AAST) developed an anatomically based severity grading system for surgical diseases, including cholecystitis. Because the Tokyo Guidelines represent the gold standard to estimate acute cholecystitis severity, we wished to validate the AAST emergency general surgery scoring system and compare the performance of both systems for several patient outcomes. METHODS: Adults (≥18 years) with acute cholecystitis during 2013-2016 were identified. Baseline demographic characteristics, comorbidity severity as defined by Charlson Comorbidity Index score, procedure types, and AAST and Tokyo Guidelines 2013 grades were abstracted. Outcomes included duration of stay, 30-day mortality, and complications. Comparison of the Tokyo Guidelines and AAST grading system was performed using receiver operating characteristic (AUROC) curve C statistics. RESULTS: There were 443 patients, with a mean (±standard deviation) age of 64.8 (±18) years, 59% male. The median (interquartile ratio) Charlson Comorbidity score was 3 (0-6). Management included laparoscopic (n = 307, 69.3%), open (n = 26, 6%), laparoscopy converted to laparotomy (n = 53, 12%), and cholecystostomy (n = 57, 12.7%). Comparison of AAST with Tokyo Guidelines AUROC C statistics indicated (P < .05) mortality (0.86 vs 0.73), complication (0.76 vs 0.63), and cholecystostomy tube utilization (0.80 vs 0.68). CONCLUSION: Emergency general surgery grading systems improve disease severity assessment, may improve documentation, and guide management. Discrimination of disease severity using the AAST grading system outperforms the Tokyo Guidelines for key clinical outcomes. The AAST grading system requires prospective validation and further comparison.
BACKGROUND: Acute cholecystitis presents with heterogeneous severity. The Tokyo Guidelines 2013 is a validated method to assess cholecystitis severity, but the variables are multifactorial. The American Association for the Surgery of Trauma (AAST) developed an anatomically based severity grading system for surgical diseases, including cholecystitis. Because the Tokyo Guidelines represent the gold standard to estimate acute cholecystitis severity, we wished to validate the AAST emergency general surgery scoring system and compare the performance of both systems for several patient outcomes. METHODS: Adults (≥18 years) with acute cholecystitis during 2013-2016 were identified. Baseline demographic characteristics, comorbidity severity as defined by Charlson Comorbidity Index score, procedure types, and AAST and Tokyo Guidelines 2013 grades were abstracted. Outcomes included duration of stay, 30-day mortality, and complications. Comparison of the Tokyo Guidelines and AAST grading system was performed using receiver operating characteristic (AUROC) curve C statistics. RESULTS: There were 443 patients, with a mean (±standard deviation) age of 64.8 (±18) years, 59% male. The median (interquartile ratio) Charlson Comorbidity score was 3 (0-6). Management included laparoscopic (n = 307, 69.3%), open (n = 26, 6%), laparoscopy converted to laparotomy (n = 53, 12%), and cholecystostomy (n = 57, 12.7%). Comparison of AAST with Tokyo Guidelines AUROC C statistics indicated (P < .05) mortality (0.86 vs 0.73), complication (0.76 vs 0.63), and cholecystostomy tube utilization (0.80 vs 0.68). CONCLUSION: Emergency general surgery grading systems improve disease severity assessment, may improve documentation, and guide management. Discrimination of disease severity using the AAST grading system outperforms the Tokyo Guidelines for key clinical outcomes. The AAST grading system requires prospective validation and further comparison.
Authors: Sean J Donohue; Caroline E Reinke; Susan L Evans; Mary M Jordan; Yancey E Warren; Timothy Hetherington; Marc Kowalkowski; Addison K May; Brent D Matthews; Samuel W Ross Journal: Surg Endosc Date: 2021-09-03 Impact factor: 3.453
Authors: Stephanie A Savage; Shi Wen Li; Garth H Utter; Jessica A Cox; Salina M Wydo; Kevin Cahill; Babak Sarani; Jeremy Holzmacher; Therese M Duane; Rajesh R Gandhi; Martin D Zielinski; Mohamed Ray-Zack; Joshua Tierney; Trinette Chapin; Patrick B Murphy; Kelly N Vogt; Thomas J Schroeppel; Emma Callaghan; Leslie Kobayashi; Raul Coimbra; Kevin M Schuster; Devin Gillaspie; Lava Timsina; Alvancin Louis; Marie Crandall Journal: J Trauma Acute Care Surg Date: 2019-04 Impact factor: 3.313
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
Authors: Kovi E Bessoff; Jeff Choi; Sylvia Bereknyei Merrell; Aussama Khalaf Nassar; David Spain; Lisa Marie Knowlton Journal: Trauma Surg Acute Care Open Date: 2020-09-08