학술논문
How to Predict Postoperative Complications After Early Laparoscopic Cholecystectomy for Acute Cholecystitis: the Chole-Risk Score.
Document Type
Academic Journal
Author
Di Martino M; HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62 - 4th Floor, 28006, Madrid, Spain. marcellodima@gmail.com.; Mora-Guzmán I; HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62 - 4th Floor, 28006, Madrid, Spain.; Hospital General La Mancha Centro, Alcázar de San Juan, Spain.; Jodra VV; Hospital Universitario Ramón Y Cajal, Madrid, Spain.; Dehesa AS; Hospital Universitario Ramón Y Cajal, Madrid, Spain.; García DM; Hospital Universitario Marqués De Valdecilla, Santander, Spain.; Ruiz RC; Hospital Universitario Marqués De Valdecilla, Santander, Spain.; Nisa FG; Hospital El Bierzo en Ponferrada, Alcalá De Henares, Spain.; Moreno FM; Hospital El Bierzo en Ponferrada, Alcalá De Henares, Spain.; Batanero SA; Complejo Asistencial Universitario Salamanca, Salamanca, Spain.; Sampedro JEQ; Complejo Asistencial Universitario Salamanca, Salamanca, Spain.; Cumplido PL; Hospital De Cabueñes, Gijón, Spain.; Bravo AA; Hospital El Bierzo en Ponferrada, Alcalá De Henares, Spain.; Rubio-Perez I; Hospital Universitario La Paz, Madrid, Spain.; Asensio-Gomez L; Hospital Universitario La Paz, Madrid, Spain.; Aranda FP; Hospital Universitario Germans Trias I Pujol, Badalona, Spain.; Farrarons SS; Hospital Universitario Germans Trias I Pujol, Badalona, Spain.; Moreno CR; Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Moreno CMM; Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Lasarte AS; Hospital Universitario Cruces, Bilbao, Spain.; Calvo MP; Hospital Universitario Cruces, Bilbao, Spain.; Aparicio-Sánchez D; Hospital Universitario Virgen Del Rocío, Sevilla, Spain.; Del Pozo EP; Hospital Universitario Virgen Del Rocío, Sevilla, Spain.; Pellino G; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.; Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.; Martin-Perez E; HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62 - 4th Floor, 28006, Madrid, Spain.
Source
Publisher: Springer Country of Publication: United States NLM ID: 9706084 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4626 (Electronic) Linking ISSN: 1091255X NLM ISO Abbreviation: J Gastrointest Surg Subsets: MEDLINE
Subject
Language
English
Abstract
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.
(© 2021. The Society for Surgery of the Alimentary Tract.)
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.
(© 2021. The Society for Surgery of the Alimentary Tract.)