Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan‐Taiwan multicenter cohort study

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 24; no. 6; pp. 346 - 361
• Main Authors: Endo, Itaru, Takada, Tadahiro, Hwang, Tsann‐Long, Akazawa, Kohei, Mori, Rintaro, Miura, Fumihiko, Yokoe, Masamichi, Itoi, Takao, Gomi, Harumi, Chen, Miin‐Fu, Jan, Yi‐Yin, Ker, Chen‐Guo, Wang, Hsiu‐Po, Kiriyama, Seiki, Wada, Keita, Yamaue, Hiroki, Miyazaki, Masaru, Yamamoto, Masakazu
• Format: Journal Article
• Language: English
• Published: Japan Wiley Subscription Services, Inc 01.06.2017
• Subjects: Acute cholecystitis; Aged; Aged, 80 and over; Cholecystectomy; Cholecystectomy - adverse effects; Cholecystectomy - methods; Cholecystectomy, Laparoscopic - adverse effects; Cholecystectomy, Laparoscopic - methods; Cholecystitis, Acute - diagnosis; Cholecystitis, Acute - mortality; Cholecystitis, Acute - surgery; Cholecystostomy; Cohort analysis; Cohort Studies; Comorbidity; Drainage - methods; Female; Gallbladder; Gallbladder diseases; Humans; Internationality; Japan; Laparoscopic cholecystectomy; Logistic Models; Male; Middle Aged; Mortality; Multivariate Analysis; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Rate; Taiwan; Treatment Outcome; Laparoscopic cholecystectomy; Cholecystostomy; Comorbidity; Acute cholecystitis
• ISSN: 1868-6974; 1868-6982; 1868-6982
• DOI: 10.1002/jhbp.456

Background Although early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities. Methods An international multicentric retrospective observational study was conducted over a 2‐year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone. Results The subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index (CCI) scores below and above 6 (P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0–3 days after admission (P < 0.01). Multiple regression analysis revealed CCI and low body mass index <20 as predictive factors of 30‐day mortality in Grade I+II patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30‐day mortality in Grade III patients. In Grade III patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor. Conclusion Even patients with Grade III severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder drainage may have a therapeutic role in subgroups with higher CCI or higher disease severity. HighlightIn this international multicenter retrospective observational study, Endo and colleagues revealed multivariate predictive factors of 30‐day mortality to be Charlson co‐morbidity index and body mass index in Grade I+II, and jaundice, neurological dysfunction, and respiratory dysfunction in Grade III. Primary cholecystectomy is safe in Grade III if there are no predictive factors.