Acute cholecystitis in patients with diabetes mellitus - systematic review

Abstract

Introduction: According to the WHO, an estimated 422 million people are suffering from diabetes worldwide. Among them, the incidence of cholelithiasis is higher than in the healthy population. The aim of this literature review was to summarize the available evidence about acute cholecystitis in patients with diabetes. Materials and methods: This study adhered to the PRISMA guidelines. The course of hospitalization of patients with and without diabetes who underwent cholecystectomy due to acute cholecystitis was compared.Following information was abstracted from original studies: general study information, patient characteristics, complications, and recommendations for patients with diabetes. Results: Initial search provided 1632 results. After full text assessment, 40 studies met the inclusions criteria. Operative and postoperative complication rates were significantly higher among the diabetic patients. Diabetes is a risk factor for conversion from laparoscopic to open cholecystectomy method. The authors' opinions on elective surgery before the onset of acute cholecystitis symptoms are divided. Conclusions: Diabetic patients are at greater risk of developing complications. An individualized screening and treatment approach, as well as proper preparation of the diabetic patient for an elective cholecystectomy could have a positive effect on the outcome. However, the low quality of the data from the systematic review does not allow for meta-analysis, which is why we cannot draw strong conclusions.

Clinical and therapeutic features of acute cholecystitis in diabetic patients

“…Similar studies on outcomes of cholecystectomy in diabetic patients have confirmed the interdependency between DM and acute coronary syndromes (11,23). Moreover, other systemic complications have been revealed to be associated with DM including respiratory, renal decompensation, sepsis, and systemic infections (11,12,15,17). In the present study, there were no pulmonary and renal complications, and the hospital-acquired infection rates did not differ between the 2 study groups.…”

“…Ischemic heart disease has been revealed to be significantly associated with DM due to the occurrence of both large vessels (accelerated atherosclerosis) and microvascular disorders. Similar studies on outcomes of cholecystectomy in diabetic patients have confirmed the interdependency between DM and acute coronary syndromes (11,23). Moreover, other systemic complications have been revealed to be associated with DM including respiratory, renal decompensation, sepsis, and systemic infections (11,12,15,17).…”

“…The incidence of the severe cases in diabetic patients was higher than the value of that recorded in non-diabetics, but the result was not statistically significant (P=0.058; Table III). While some researchers support the association of DM with severe clinical forms of acute cholecystitis (6,11,12) larger studies are required to resolve this controversy.…”

Costs of elective vs emergency cholecystectomy in diabetic patients

“…Costs of emergency surgery in diabetic patients are significantly higher (p = 0.015) than in non-diabetic. This is due to increased levels of complications intraoperatively and in postoperative period in diabetic patients with acute cholecystitis in comparison to-non diabetics [11,19,[21][22][23][24].…”

“…Because of its many complications, diabetes mellitus is associated with significant costs in public healthcare systems around the globe [2,3]. Acute cholecystitis in diabetic patients is often complicated by gangrenous cholecystitis [1], peritonitis, preoperative perforation, impaired wound healing, infections, increased risk of cardiovascular events and renal failure [4][5][6][7][8][9][10][11]. For this reason, diabetic patients hospitalisation costs are estimated to be higher than non-diabetic.…”