TY - JOUR
T1 - How to Predict Postoperative Complications After Early Laparoscopic Cholecystectomy for Acute Cholecystitis
T2 - the Chole-Risk Score
AU - Di Martino, Marcello
AU - Mora-Guzmán, Ismael
AU - Jodra, Víctor Vaello
AU - Dehesa, Alfonso Sanjuanbenito
AU - García, Dieter Morales
AU - Ruiz, Rubén Caiña
AU - Nisa, Francisca García Moreno
AU - Moreno, Fernando Mendoza
AU - Batanero, Sara Alonso
AU - Sampedro, José Edecio Quiñones
AU - Cumplido, Paola Lora
AU - Bravo, Altea Arango
AU - Rubio-Perez, Ines
AU - Asensio-Gomez, Luis
AU - Aranda, Fernando Pardo
AU - Farrarons, Sara Sentí
AU - Moreno, Cristina Ruiz
AU - Moreno, Clara Maria Martinez
AU - Lasarte, Aingeru Sarriugarte
AU - Calvo, Mikel Prieto
AU - Aparicio-Sánchez, Daniel
AU - Del Pozo, Eduardo Perea
AU - Pellino, Gianluca
AU - Martin-Perez, Elena
N1 - Publisher Copyright:
© 2021, The Society for Surgery of the Alimentary Tract.
PY - 2021/11
Y1 - 2021/11
N2 - Background: Early laparoscopic cholecystectomy (ELC) is the gold standard treatment for patients with acute calculous cholecystitis (ACC); however, it is still related to significant postoperative complications. The aim of this study is to identify factors associated with an increased risk of postoperative complications and develop a preoperative score able to predict them. Methods: Multicentric retrospective analysis of 1868 patients with ACC submitted to ELC. Included patients were divided into two groups according to the presentation of increased postoperative complications defined as postoperative complications ≥ Clavien-Dindo IIIa, length of stay greater than 10 days and readmissions within 30 days of discharge. Variables that were independently predictive of increased postoperative complications were combined determining the Chole-Risk Score, which was validated through a correlation analysis. Results: We included 282 (15.1%) patients with postoperative complications. The multivariate analysis predictors of increased morbidity were previous percutaneous cholecystostomy (OR 2.95, p=0.001), previous abdominal surgery (OR 1.57, p=0.031) and diabetes (OR 1.62, p=0.005); Charlson Comorbidity Index >6 (OR 2.48, p=0.003), increased total bilirubin > 2 mg/dL (OR 1.88, p=0.002), dilated bile duct (OR 1.79, p=0.027), perforated gallbladder (OR 2.62, p<0.001) and severity grade (OR 1.93, p=0.001). The Chole-Risk Score was generated by grouping these variables into four categories, with scores ranging from 0 to 4. It presented a progressive increase in postoperative complications ranging from 5.8% of patients scoring 0 to 47.8% of patients scoring 4 (p<0.001). Conclusion: The Chole-Risk Score represents an intuitive tool capable of predicting postoperative complications in patients with ACC.
AB - Background: Early laparoscopic cholecystectomy (ELC) is the gold standard treatment for patients with acute calculous cholecystitis (ACC); however, it is still related to significant postoperative complications. The aim of this study is to identify factors associated with an increased risk of postoperative complications and develop a preoperative score able to predict them. Methods: Multicentric retrospective analysis of 1868 patients with ACC submitted to ELC. Included patients were divided into two groups according to the presentation of increased postoperative complications defined as postoperative complications ≥ Clavien-Dindo IIIa, length of stay greater than 10 days and readmissions within 30 days of discharge. Variables that were independently predictive of increased postoperative complications were combined determining the Chole-Risk Score, which was validated through a correlation analysis. Results: We included 282 (15.1%) patients with postoperative complications. The multivariate analysis predictors of increased morbidity were previous percutaneous cholecystostomy (OR 2.95, p=0.001), previous abdominal surgery (OR 1.57, p=0.031) and diabetes (OR 1.62, p=0.005); Charlson Comorbidity Index >6 (OR 2.48, p=0.003), increased total bilirubin > 2 mg/dL (OR 1.88, p=0.002), dilated bile duct (OR 1.79, p=0.027), perforated gallbladder (OR 2.62, p<0.001) and severity grade (OR 1.93, p=0.001). The Chole-Risk Score was generated by grouping these variables into four categories, with scores ranging from 0 to 4. It presented a progressive increase in postoperative complications ranging from 5.8% of patients scoring 0 to 47.8% of patients scoring 4 (p<0.001). Conclusion: The Chole-Risk Score represents an intuitive tool capable of predicting postoperative complications in patients with ACC.
KW - cholecystectomy
KW - cholecystitis
KW - early laparoscopic cholecystectomy
KW - postoperative complication
UR - http://www.scopus.com/inward/record.url?scp=85101570504&partnerID=8YFLogxK
U2 - 10.1007/s11605-021-04956-9
DO - 10.1007/s11605-021-04956-9
M3 - Article
C2 - 33629230
AN - SCOPUS:85101570504
SN - 1091-255X
VL - 25
SP - 2814
EP - 2822
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 11
ER -