Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines

Abstract

Background Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. Methods Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. Results The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7–12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34–12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02–1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5–28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). Conclusions Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. Trial registration Retrospectively registered and recorded in Clinical Trials. NCT04744441

Hybrid Single-Port Cholecystectomy Pediatric Gallbladder Volvulus

“…The first pediatric case was described in 1925 by Daux, with subsequent reports stressing the diagnostic challenge and high mortality if not promptly treated [7,8]. The diagnosis of gallbladder volvulus has an estimated mortality rate of 5% even with early diagnosis and surgical intervention, which is notably higher than the estimated 3.6% mortality of acute cholecystitis [9]. The increased mortality of gallbladder volvulus is attributed to strangulation of the cystic artery, which progresses to gallbladder necrosis and perforation with a near 100% mortality rate [10].…”

Correlation of Inpatients Suffering from Acute Acalculous Cholecystitis during ICU Treatment with Acute Physiology and Chronic Health Evaluation II Score, Duration of Ventilator Use, and Time on Total Parenteral Nutrition

“…(2) The patients met the diagnosis criteria for AAC [12] (3) The patients were clearly diagnosed with normal gallbladder on admission and then were diagnosed with AAC during ICU treatment (4) The patients were at least 18 years old (5) The patients did not have severe cirrhosis, liver failure, acute leukemia, and other diseases (6) The patients were confirmed to have no cholecystolithiasis and choledocholith after imaging examination (7) The patients did not have the history of cholecystectomy (8) The patients had complete clinical data (9) The patients and their family members understood the study and signed the informed consent Finally, 47 AAC patients who were treated in our hospital from March 2016 to March 2022 and met the study criteria were selected as the AAC group.…”

“…Acute acalculous cholecystitis (AAC) is a clinical emergency with lower morbidity, which tends to occur in critically ill patients with severe trauma, burns, shock, hypotension, or after major surgery, is featured with insidious onset, atypical clinical presentation, and rapid progression of the condition, and easily causes perforated gangrene and other complica-tions, leading to a high clinical mortality [1][2][3][4]. Most patients treated in ICU inpatient areas are critically ill with complex condition and often accompanied by multivisceral dysfunction, so they are at high risk for AAC; in addition, patients who undergo the therapeutic means such as sedation and mechanical ventilation often have disorders of consciousness, and thus, the condition of AAC is not easily perceived, resulting in a prolonged disease course and a high clinical mortality rate of 45-50% [5][6][7][8]. To enable clinicians to better monitor patients' gallbladder changes, control patients' conditions, and realize early detection, diagnosis, and treatment of AAC, a detailed analysis of each risk factor that can easily trigger AAC is required.…”

Revision of the AAST grading scale for acute cholecystitis with comparison to physiologic measures of severity

“…Acute cholecystitis is one of the most common acute surgical conditions in the United States representing over 215,000 annual hospital admissions and over $3 billion in charges 1 . Notwithstanding the generally younger age range associated with cholecystitis, it continues to carry a mortality risk that may be as high as 3.6% 2 . Acute cholecystitis is generally treated with laparoscopic cholecystectomy during the index hospitalization with an overall low risk of complications 3 .…”

“…1 Notwithstanding the generally younger age range associated with cholecystitis, it continues to carry a mortality risk that may be as high as 3.6%. 2 Acute cholecystitis is generally treated with laparoscopic cholecystectomy during the index hospitalization with an overall low risk of complications. 3 That risk, however, may be as high as 9% for major complications despite being one of the most common operations performed in the United States.…”