Severity of Acute Cholecystitis and Risk of Iatrogenic Bile Duct Injury During Cholecystectomy, a Population‐Based Case–Control Study

Törnqvist, Björn; Waage, Anne; Zheng, Zongli; Ye, Weimin; Nilsson, Magnus

doi:10.1007/s00268-015-3365-1

Cited by 107 publications

(77 citation statements)

References 40 publications

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“…Other studies have reported BDI rates of 0.62–0.9% for LC and 0.38–1.24% for OC [26–28]. These studies were however not homogenous for acute cholecystitis for which the risk of BDI has been reported as twice as high compared with patients who undergo cholecystectomy electively [29]. …”

Section: Discussionmentioning

confidence: 99%

Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications

2016

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BackgroundThe purpose of the study was to identify risk factors for conversion of laparoscopic cholecystectomy and risk factors for postoperative complications in acute calculous cholecystitis. The most common complications arising from cholecystectomy were also to be identified.MethodsA total of 499 consecutive patients, who had undergone emergent cholecystectomy with diagnosis of cholecystitis in Meilahti Hospital in 2013–2014, were identified from the hospital database. Of the identified patients, 400 had acute calculous cholecystitis of which 27 patients with surgery initiated as open cholecystectomy were excluded, resulting in 373 patients for the final analysis. The Clavien-Dindo classification of surgical complications was used.ResultsLaparoscopic cholecystectomy was initiated in 373 patients of which 84 (22.5%) were converted to open surgery. Multivariate logistic regression identified C-reactive protein (CRP) over 150 mg/l, age over 65 years, diabetes, gangrene of the gallbladder and an abscess as risk factors for conversion. Complications were experienced by 67 (18.0%) patients. Multivariate logistic regression identified age over 65 years, male gender, impaired renal function and conversion as risk factors for complications.ConclusionsAdvanced cholecystitis with high CRP, gangrene or an abscess increase the risk of conversion. The risk of postoperative complications is higher after conversion. Early identification and treatment of acute calculous cholecystitis might reduce the number of patients with advanced cholecystitis and thus improve outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-016-0111-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications

2016

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“…These include difficulties at the patient level such as inability to schedule and keep appointments and at a systems level where referrals may or may not be appropriately made to surgical outpatients. 22 Recurrent episodes of acute biliary pain that occur whilst awaiting operative management may result in pericholecystic adhesions which may contribute to technical difficulties and surgical morbidity. 19 The detrimental effects of biliary colic affect patients, the healthcare network and society.…”

Section: Discussionmentioning

confidence: 99%

Emergency presentations of acute biliary pain: changing patterns of management in a tertiary institute

Cox

Fong

Liew

et al. 2018

ANZ Journal of Surgery

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Background: Acute biliary pain is the most common presentation of gallstone disease. Untreated patients risk recurrent pain, cholecystitis, obstructive jaundice, pancreatitis and multiple hospital presentations. We examine the outcome of implementing a policy to offer laparoscopic cholecystectomy on index presentation to patients with biliary colic in a tertiary hospital in Australia. Methods: This is a retrospective cohort study of adult patients presenting to the emergency department (ED) with biliary pain during three 12-month periods. Outcomes in Group A, 3 years prior to policy implementation, were compared with groups 2 and 7 years post implementation (Groups B and C). Primary outcomes were representations to ED, admission rate and time to cholecystectomy. Results: A total of 584 patients presented with biliary colic during the three study periods. Of these, 391 underwent cholecystectomy with three Strasberg Type A bile leaks and no bile duct injuries. The policy increased admission rates (A = 15.8%, B = 62.9%, C = 29.5%, P < 0.001) and surgery on index presentation (A = 12.0%, B = 60.7%, C = 27.4%, P < 0.001). There was a decline in time to cholecystectomy (days) (A = 143, B = 15, C = 31, P < 0.001), post-operative length of stay (days) (A = 3.6, B = 3.2, C = 2.0, P < 0.05) and representation rates to ED (A = 42.1%, B = 7.1%, C = 19.9%, P < 0.001). There was a decline in policy adherence in the later cohort. Conclusion: Index hospital admission and cholecystectomy for biliary colic decrease patient representations, time to surgery, post-operative stay and complications of gallstone disease. This study demonstrates the impact of the policy with initial improvement, the dangers of policy attrition and the need for continued reinforcement.

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“…A complex or prolonged operation may result from unexpected intra‐operative findings that cannot be dealt with by on‐call surgeons or trainees who do not have the requisite skills or experience. Severe inflammation around the gallbladder (GB) can make safe dissection difficult, and may increase the risk of both minor and major complications . When an early LC policy is adopted for patients with acute biliary presentations it would be helpful to predict the degree of operative difficulty.…”

Section: Introductionmentioning

confidence: 99%

Predicting operative difficulty of laparoscopic cholecystectomy in patients with acute biliary presentations

Wennmacker

Bhimani

Dijk

et al. 2019

ANZ Journal of Surgery

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BackgroundEarly laparoscopic cholecystectomy (LC) is advocated in patients with an acute biliary presentation but may require some precaution. We aimed to assess the intra‐operative difficulty of cholecystectomy in patients who underwent early intervention, and to establish a prediction model for a ‘complicated’ LC.MethodsRetrospective analysis of prospectively collected data from patients presenting to the emergency department with acute biliary symptoms, and who subsequently underwent early LC between 2015 and 2018. Operative difficulty was assessed by standardized grading of intra‐operative findings (grades 1–4). Pre‐operative predictors for a ‘complicated’ LC (grades 3/4) were assessed using univariable and multivariable logistic regression analysis. A prediction model was created using variable regression coefficients. Cut‐off and accuracy of the model were assessed using a receiver operating characteristic curve.ResultsA total of 185 patients were included and 59% presented with acute cholecystitis. In this cohort 113 (61%) patients underwent a ‘complicated’ LC. A prediction model for a ’complicated’ LC (0–4.5 points) included: clinical diagnosis of acute cholecystitis (2 points), C‐reactive protein >10.5 mg/L (1.5 points) and pericholecystic fluid on pre‐operative imaging (1 point). A score ≥2.5 had a sensitivity of 77.7%, specificity of 81.7% and positive and negative predictive values of 87.0% and 69.9%, respectively.ConclusionEarly LC may be ‘complicated’ in up to 60% of cases. The presented prediction model uses readily available information in the emergency department and is a simple but accurate way to predict a likely ‘complicated’ LC in patients with acute biliary presentations.

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Severity of Acute Cholecystitis and Risk of Iatrogenic Bile Duct Injury During Cholecystectomy, a Population‐Based Case–Control Study

Cited by 107 publications

References 40 publications

Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications

Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications

Emergency presentations of acute biliary pain: changing patterns of management in a tertiary institute

Predicting operative difficulty of laparoscopic cholecystectomy in patients with acute biliary presentations

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