학술논문
Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study
Document Type
Clinical report
Author
Fugazzola, Paola; Cobianchi, Lorenzo; Di Martino, Marcello; Tomasoni, Matteo; Dal Mas, Francesca; Abu-Zidan, Fikri M.; Agnoletti, Vanni; Ceresoli, Marco; Coccolini, Federico; Di Saverio, Salomone; Dominioni, Tommaso; Farè, Camilla Nikita; Frassini, Simone; Gambini, Giulia; Leppäniemi, Ari; Maestri, Marcello; Martín-Pérez, Elena; Moore, Ernest E.; Musella, Valeria; Peitzman, Andrew B.; de la Hoz Rodríguez, Ãngela; Sargenti, Benedetta; Sartelli, Massimo; Viganò, Jacopo; Anderloni, Andrea; Biffl, Walter; Catena, Fausto; Ansaloni, Luca; Augustin, Goran; MoriÄ, Trpimir; Awad, Selmy; Alzahrani, Azzah M.; Elbahnasawy, Mohamed; Massalou, Damien; De Simone, Belinda; Demetrashvili, Zaza; Kimpizi, Athina-Despoina; Schizas, Dimitrios; Balalis, Dimitrios; Tasis, Nikolaos; Papadoliopoulou, Maria; Georgios, Petrakis; Lasithiotakis, Konstantinos; Ioannidis, Orestis; Bains, Lovenish; Magnoli, Matteo; Cianci, Pasquale; Conversano, Nunzia Ivana; Pasculli, Alessandro; Andreuccetti, Jacopo; Arici, Elisa; Pignata, Giusto; Tiberio, Guido A. M.; Podda, Mauro; Murru, Cristina; Veroux, Massimiliano; Distefano, Costanza; Centonze, Danilo; Favi, Francesco; Bova, Raffaele; Convertini, Girolamo; Balla, Andrea; Sasia, Diego; Giraudo, Giorgio; Gabriele, Anania; Tartaglia, Nicola; Pavone, Giovanna; D'Acapito, Fabrizio; Fabbri, Nicolò; Ferrara, Francesco; Cimbanassi, Stefania; Ferrario, Luca; Cioffi, Stefano; Fumagalli, Chiara; Degrate, Luca; Degiuli, Maurizio; Sofia, Silvia; Licari, Leo; Improta, Mario; Patriti, Alberto; Coletta, Diego; Conti, Luigi; Malerba, Michele; Andrea, Muratore; Calabrò, Marcello; De Zolt, Beatrice; Bellio, Gabriele; Giordano, Alessio; Luppi, Davide; Corbellini, Carlo; Sampietro, Gianluca Matteo; Marafante, Chiara; Rossi, Stefano; Mingoli, Andrea; Lapolla, Pierfrancesco; Cicerchia, Pierfranco M.; Siragusa, Leandro; Grande, Michele; Arcudi, Claudio; Antonelli, Amedeo; Vinci, Danilo; De Martino, Ciro; Armellino, Mariano Fortunato; Bisogno, Enrica; Visconti, Diego; Santarelli, Mauro; Montanari, Elena; Biloslavo, Alan; Germani, Paola; Zaghi, Claudia; Oka, Naoki; Fathi, Mohd Azem; Ríos-Cruz, Daniel; Hernandez, Edgard Efren Lozada; Garzali, Ibrahim Umar; Duarte, Liliana; Negoi, Ionut; Litvin, Andrey; Chowdhury, Sharfuddin; Alshahrani, Salem M.; Carbonell-Morote, Silvia; Rubio-Garcia, Juan J.; Moreira, Claudia Cristina Lopes; Ponce, Iéigo Augusto; Mendoza-Moreno, Fernando; Campaéa, Anna Muéoz; Bayo, Heura Llaquet; Serra, Andrea Campos; Landaluce-Olavarria, Aitor; Serradilla-Martín, Mario; Cano-Paredero, Antonio; Dobón-Rascón, Miguel Ãngel; Hamid, Hytham; Baraket, Oussama; Gonullu, Emre; Leventoglu, Sezai; Turk, Yilmaz; Büyükkasap, ÇaÄri; Aday, UlaÅ; Kara, Yasin; Kabuli, Hamit Ahmet; Atici, Semra Demirli; Colak, Elif; Chooklin, Serge; Chuklin, Serhii; Ruta, Federico; Estraviz-Mateos, Begoéa; Markinez-Gordobil, Izaskun
Source
World Journal of Emergency Surgery. March 18, 2023, Vol. 18 Issue 1
Subject
Language
English
ISSN
1749-7922
Abstract
Author(s): Paola Fugazzola[sup.1], Lorenzo Cobianchi[sup.1,2], Marcello Di Martino[sup.3], Matteo Tomasoni[sup.1], Francesca Dal Mas[sup.4], Fikri M. Abu-Zidan[sup.5], Vanni Agnoletti[sup.6], Marco Ceresoli[sup.7], Federico Coccolini[sup.8], Salomone Di Saverio[sup.9], Tommaso Dominioni[sup.1], Camilla Nikita Farè[sup.1], [...]
Background Less invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models. Method The S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models--POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade--receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities. Results A 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a 'Chole-POSSUM' score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96-97% negative predictive value for major complications. Conclusions The Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action. Trial Registration: ClinicalTrial.gov NCT04995380. Keywords: Cholecystectomy, Acute cholecystitis, Surgical risk, POSSUM
Background Less invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models. Method The S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models--POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade--receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities. Results A 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a 'Chole-POSSUM' score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96-97% negative predictive value for major complications. Conclusions The Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action. Trial Registration: ClinicalTrial.gov NCT04995380. Keywords: Cholecystectomy, Acute cholecystitis, Surgical risk, POSSUM