Risk Factors of Postoperative Complications in Laparoscopic Cholecystectomy for Acute Cholecystitis

Sato, Manabu; Endo, Katsuhiro; Harada, Akihiko; Shijo, Masahiro

doi:10.4293/jsls.2020.00049

Cited by 7 publications

(11 citation statements)

References 29 publications

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“…This study allows for the identification of some of these risk factors. Similar studies have concentrated on risk factors for conversion to open surgery, looked at outcomes in cohorts including emergency patients or focused purely on selected groups such as elderly patients [1,2,4,[9][10][11]. The unique strength of this paper is that it considers a variety of generic outcomes in a large cohort of unselected patients scheduled to undergo ELLC.…”

Section: Discussionmentioning

confidence: 99%

“…It has previously been shown that severe cholecystitis is associated with post-operative complications following emergency operation [ 4 ]. Until this study, it was unclear how the risk of post-operative complications changes in the elective setting after episodes of cholecystitis.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have identified factors associated with technically challenging surgery including the presence of acute cholecystitis, thickened gallbladder wall, comorbidities and age greater than 65 years [ 1 – 3 ]. Other studies have determined variables associated with post-operative complications following emergency LC [ 4 ].…”

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confidence: 99%

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Elective laparoscopic cholecystectomy: recurrent biliary admissions predispose to difficult cholecystectomy

2022

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Introduction Patients undergoing elective laparoscopic cholecystectomy (ELLC) represent a heterogeneous group making it challenging to stratify risk. The aim of this paper is to identify pre-operative factors associated with adverse peri- and post-operative outcomes in patients undergoing ELLC. This knowledge will help stratify risk, guide surgical decision making and better inform the consent process. Methods All patients who underwent ELLC between January 2015 and December 2019 were included in the study. Pre-operative data and both peri- and post-operative outcomes were collected retrospectively from multiple databases using a deterministic records-linkage methodology. Patients were divided into groups based on clinical indication (i.e. biliary colic versus cholecystitis) and adverse outcomes were compared. Multivariate regression models were generated for each adverse outcome using pre-operative independent variables. Results Two-thousand one hundred and sixty-six ELLC were identified. Rates of peri- and post-operative adverse outcomes were significantly higher in the cholecystitis versus biliary colic group and increased with number of admissions of cholecystitis (p < 0.05). Rates of subtotal (29.5%), intra-operative complication (9.8%), post-operative complications (19.6%), prolonged post-operative stay (45.9%) and re-admission (16.4%) were significant in the group of patients with ≥ 2 admissions with cholecystitis. Conclusion Our data demonstrate that patients with repeated biliary admission (particularly cholecystitis) ultimately face an increased risk of a difficult ELLC with associated complications, prolonged post-operative stay and readmissions. These data provide robust evidence that individualised risk assessment and consent are necessary before ELLC. Strategies to minimise recurrent biliary admissions prior to LC should be implemented.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Elective laparoscopic cholecystectomy: recurrent biliary admissions predispose to difficult cholecystectomy

2022

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“…Laparoscopic cholecystectomy (LC) is still the main treatment for acute cholecystitis. However, the incidence of surgical complications is relatively high in patients with elderly, more comorbidities, and severe infection [13] . PTGBD is used as a transitional therapy to reduce the patient's gallbladder tension and drainage bile through the puncture, thus achieving the goal that converting emergency operation to elective.…”

Section: Discussionmentioning

confidence: 99%

Effect of multimodal prehabilitation on major outcomes of laparoscopic cholecystectomy after emergency percutaneous transhepatic gallbladder drainage in the elderly patients - A real-world based retrospective cohort study

Liu

et al. 2022

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Background & aims: Multimodal prehabilitation is a new concept of preoperative management. We aimed to study the effectiveness of multimodal prehabilitation in the elderly patients who would receive laparoscopic cholecystectomy (LC) after emergency percutaneous transhepatic gallbladder drainage (PTGBD) . Methods This is a retrospective cohort study. Consecutive patients undergoing LC after emergency PTGBD between January 2020 to April 2021 were recruited. Patients over 70years old were treated by multimodal prehabilitation before LC including nutrition support, exercise and psychological interventions as prehabilitation group. Other patients were included as the control group. Perioperative parameters and outcomes were compared between groups. Results 43 cases were included in this research.24 cases were in the prehabilitation group. Comparing the prehabilitation and control groups, no statistical difference was detected in the laboratory examination before LC except hemoglobin and albumin. There were also no statistical difference in the rates of postoperative complications (8.33%vs.5.26%, P = 0.144) and conversion to open surgery (8.33%vs.5.26%, P = 0.144). Conclusion Multimodal prehabilitation could make the rate of major outcomes of LC after emergency PTGBD close to the young patients in the elderly patients.

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“…The model was validated by an internal retrospective analysis. Recently, some other well-known risk prediction models (POSSUM [ 9 , 10 ], modified Frailty Index (mFI) [ 11 ], CCI [ 12 ]) have been applied and validated for EC in patients with ACC, but almost all are missing a formal perspective or external validation. A systematic review and meta-analysis looking at the ability of prognostic factors or risk prediction models to predict outcomes in patients with ACC after EC, showed that, up to now, no reliable model has been identified [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study

et al. 2023

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Background Less invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models. Method The S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models—POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade—receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities. Results A 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a ‘Chole-POSSUM’ score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96–97% negative predictive value for major complications. Conclusions The Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action. Trial Registration: ClinicalTrial.gov NCT04995380.

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Risk Factors of Postoperative Complications in Laparoscopic Cholecystectomy for Acute Cholecystitis

Cited by 7 publications

References 29 publications

Elective laparoscopic cholecystectomy: recurrent biliary admissions predispose to difficult cholecystectomy

Elective laparoscopic cholecystectomy: recurrent biliary admissions predispose to difficult cholecystectomy

Effect of multimodal prehabilitation on major outcomes of laparoscopic cholecystectomy after emergency percutaneous transhepatic gallbladder drainage in the elderly patients - A real-world based retrospective cohort study

Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study

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