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

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  • dc.contributor.author González Castillo, Ana María
  • dc.contributor.author Sancho Insenser, Juan
  • dc.contributor.author Miguel Palacio, Maite de
  • dc.contributor.author Morera Casaponsa, Josep Ricard
  • dc.contributor.author Membrilla Fernández, Estela
  • dc.contributor.author Pons Fragero, María José
  • dc.contributor.author Pera Roman, Miguel
  • dc.contributor.author Grande Posa, Luís
  • dc.date.accessioned 2021-11-04T07:37:08Z
  • dc.date.available 2021-11-04T07:37:08Z
  • dc.date.issued 2021
  • dc.description.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.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation González-Castillo AM, Sancho-Insenser J, De Miguel-Palacio M, Morera-Casaponsa JR, Membrilla-Fernández E, Pons-Fragero MJ, Pera-Román M, Grande-Posa L. Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines. World J Emerg Surg. 2021;16(1):24. DOI: 10.1186/s13017-021-00368-x
  • dc.identifier.doi http://dx.doi.org/10.1186/s13017-021-00368-x
  • dc.identifier.issn 1749-7922
  • dc.identifier.uri http://hdl.handle.net/10230/48898
  • dc.language.iso eng
  • dc.publisher BioMed Central
  • dc.relation.ispartof World J Emerg Surg. 2021;16(1):24
  • dc.rights © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data ma
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by/4.0/
  • dc.subject.keyword Acute calculous cholecystitis
  • dc.subject.keyword Acute cholecystitis
  • dc.subject.keyword Charlson Comorbidity Index
  • dc.subject.keyword Delayed cholecystectomy
  • dc.subject.keyword Early cholecystectomy
  • dc.subject.keyword High-risk patient
  • dc.subject.keyword Mortality
  • dc.subject.keyword Non-surgical treatment
  • dc.subject.keyword Percutaneous cholecystostomy
  • dc.subject.keyword Tokyo Guidelines
  • dc.title Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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