학술논문
The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?
Document Type
Clinical report
Author
De Simone, Belinda; Abu-Zidan, Fikri M.; Chouillard, Elie; Di Saverio, Salomone; Sartelli, Massimo; Podda, Mauro; Gomes, Carlos Augusto; Moore, Ernest E.; Moug, Susan J.; Ansaloni, Luca; Kluger, Yoram; Coccolini, Federico; Landaluce-Olavarria, Aitor; Estraviz-Mateos, Begoéa; Uriguen-Etxeberria, Ana; Giordano, Alessio; Luna, Alfonso Palmieri; Amín, Luz Adriana Hernández; Hernández, Adriana María Palmieri; Shabana, Amanda; Dzulkarnaen, Zakaria Andee; Othman, Muhammad Asyraf; Sani, Mohamad Ikhwan; Balla, Andrea; Scaramuzzo, Rosa; Lepiane, Pasquale; Bottari, Andrea; Staderini, Fabio; Cianchi, Fabio; Cavallaro, Andrea; Zanghì, Antonio; Cappellani, Alessandro; Campagnacci, Roberto; Maurizi, Angela; Martinotti, Mario; Ruggieri, Annamaria; Jusoh, Asri Che; Rahman, Karim Abdul; Zulkifli, Anis Suraya M.; Petronio, Barbara; Matías-García, Belén; Quiroga-Valcárcel, Ana; Mendoza-Moreno, Fernando; Atanasov, Boyko; Campanile, Fabio Cesare; Vecchioni, Ilaria; Cardinali, Luca; Travaglini, Grazia; Sebastiani, Elisa; Chooklin, Serge; Chuklin, Serhii; Cianci, Pasquale; Restini, Enrico; Capuzzolo, Sabino; Currò, Giuseppe; Filippo, Rosalinda; Rispoli, Michele; Aparicio-Sánchez, Daniel; Muéóz-Cruzado, Virginia Durán; Barbeito, Sandra Dios; Delibegovic, Samir; Kesetovic, Amar; Sasia, Diego; Borghi, Felice; Giraudo, Giorgio; Visconti, Diego; Doria, Emanuele; Santarelli, Mauro; Luppi, Davide; Bonilauri, Stefano; Grossi, Ugo; Zanus, Giacomo; Sartori, Alberto; Piatto, Giacomo; De Luca, Maurizio; Vita, Domenico; Conti, Luigi; Capelli, Patrizio; Cattaneo, Gaetano Maria; Marinis, Athanasios; Vederaki, Styliani-Aikaterini; Bayrak, Mehmet; Altintas, Yasemin; Uzunoglu, Mustafa Yener; Demirbas, Iskender Eren; Altinel, Yuksel; Meric, Serhat; Aktimur, Yunus Emre; Uymaz, Derya Salim; Omarov, Nail; Azamat, Ibrahim; Lostoridis, Eftychios; Nagorni, Eleni-Aikaterini; Pujante, Antonio; Anania, Gabriele; Bombardini, Cristina; Bagolini, Francesco; Gonullu, Emre; Mantoglu, Baris; Capoglu, Recayi; Cappato, Stefano; Muzio, Elena; Colak, Elif; Polat, Suleyman; Koylu, Zehra Alan; Altintoprak, Fatih; Bayhan, Zülfü; Akin, Emrah; Andolfi, Enrico; Rezart, Sulce; Kim, Jae Il; Jung, Sung Won; Shin, Yong Chan; Enciu, Octavian; Toma, Elena Adelina; Medas, Fabio; Canu, Gian Luigi; Cappellacci, Federico; D'Acapito, Fabrizio; Ercolani, Giorgio; Solaini, Leonardo; Roscio, Francesco; Clerici, Federico; Gelmini, Roberta; Serra, Francesco; Rossi, Elena Giulia; Fleres, Francesco; Clarizia, Guglielmo; Spolini, Alessandro; Ferrara, Francesco; Nita, Gabriela; Sarnari, Jlenia; Gachabayov, Mahir; Abdullaev, Abakar; Poillucci, Gaetano; Palini, Gian Marco; Veneroni, Simone; Garulli, Gianluca; Piccoli, Micaela; Pattacini, Gianmaria Casoni; Pecchini, Francesca; Argenio, Giulio; Armellino, Mariano Fortunato; Brisinda, Giuseppe; Tedesco, Silvia; Fransvea, Pietro; Ietto, Giuseppe; Franchi, Caterina; Carcano, Giulio; Martines, Gennaro; Trigiante, Giuseppe; Negro, Giulia; Vega, Gustavo Machain; González, Agustín Rodríguez; Ojeda, Leonardo; Piccolo, Gaetano; Bondurri, Andrea; Maffioli, Anna; Guerci, Claudio; Sin, Boo Han; Zuhdi, Zamri; Azman, Azlanudin; Mousa, Hussam; al Bahri, Shadi; Augustin, Goran; Romic, Ivan; Moric, Trpimir; Nikolopoulos, Ioannis; Andreuccetti, Jacopo; Pignata, Giusto; D'Alessio, Rossella; Kenig, Jakub; Skorus, Urszula; Fraga, Gustavo Pereira; Hirano, Elcio Shiyoiti; de Lima Bertuol, Jackson Vinícius; Isik, Arda; Kurnaz, Eray; Asghar, Mohammad Sohail; Afzal, Ameer; Akbar, Ali; Nikolouzakis, Taxiarchis Konstantinos; Lasithiotakis, Konstantinos; Chrysos, Emmanuel; Das, Koray; üzer, Nazmi; Seker, Ahmet; Ibrahim, Mohamed; Hamid, Hytham K. S.; Babiker, Ahmed; Bouliaris, Konstantinos; Koukoulis, George; Kolla, Chrysoula-Christina; Lucchi, Andrea; Agostinelli, Laura; Taddei, Antonio; Fortuna, Laura; Agostini, Carlotta; Licari, Leo; Viola, Simona; Callari, Cosimo; Laface, Letizia; Abate, Emmanuele; Casati, Massimiliano; Anastasi, Alessandro; Canonico, Giuseppe; Gabellini, Linda; Tosi, Lorenzo; Guariniello, Anna; Zanzi, Federico; Bains, Lovenish; Sydorchuk, Larysa; Iftoda, Oksana; Sydorchuk, Andrii; Malerba, Michele; Costanzo, Federico; Galleano, Raffaele; Monteleone, Michela; Costanzi, Andrea; Riva, Carlo; WalÄdziak, Maciej; Kwiatkowski, Andrzej; Czyżykowski, Åukasz; Major, Piotr; StrzaÅka, Marcin; Matyja, Maciej; Natkaniec, Michal; Valenti, Maria Rosaria; Di Vita, Maria Domenica Pia; Sotiropoulou, Maria; Kapiris, Stylianos; Massalou, Damien; Veroux, Massimiliano; Volpicelli, Alessio; Gioco, Rossella; Uccelli, Matteo; Bonaldi, Marta; Olmi, Stefano; Nardi, Matteo; Livadoti, Giada; Mesina, Cristian; Dumitrescu, Theodor Viorel; Ciorbagiu, Mihai Calin; Ammendola, Michele; Ammerata, Giorgio; Romano, Roberto; Slavchev, Mihail; Misiakos, Evangelos P.; Pikoulis, Emmanouil; Papaconstantinou, Dimitrios; Elbahnasawy, Mohamed; Abdel-elsalam, Sherief; Felsenreich, Daniel M.; Jedamzik, Julia; Michalopoulos, Nikolaos V.; Sidiropoulos, Theodoros A.; Papadoliopoulou, Maria; Cillara, Nicola; Deserra, Antonello; Cannavera, Alessandro; Negoi, IonuÅ£; Schizas, Dimitrios; Syllaios, Athanasios; Vagios, Ilias; Gourgiotis, Stavros; Dai, Nick; Gurung, Rekha; Norrey, Marcus; Pesce, Antonio; Feo, Carlo Vittorio; Fabbri, Nicolo'; Machairas, Nikolaos; Dorovinis, Panagiotis; Keramida, Myrto D.; Mulita, Francesk; Verras, Georgios Ioannis; Vailas, Michail; Yalkin, Omer; Iflazoglu, Nidal; Yigit, Direnc; Baraket, Oussama; Ayed, Karim; Ghalloussi, Mohamed hedi; Patias, Parmenion; Ntokos, Georgios; Rahim, Razrim; Bala, Miklosh; Kedar, Asaf; Sawyer, Robert G.; Trinh, Anna; Miller, Kelsey; Sydorchuk, Ruslan; Knut, Ruslan; Plehutsa, Oleksandr; Liman, Rumeysa Kevser; Ozkan, Zeynep; Kader, Saleh Abdel; Gupta, Sanjay; Gureh, Monika; Saeidi, Sara; Aliakbarian, Mohsen; Dalili, Amin; Shoko, Tomohisa; Kojima, Mitsuaki; Nakamoto, Raira; Atici, Semra Demirli; Tuncer, Gizem Kilinc; Kaya, Tayfun; Delis, Spiros G.; Rossi, Stefano; Picardi, Biagio; del Monte, Simone Rossi; Triantafyllou, Tania; Theodorou, Dimitrios; Pintar, Tadeja; Salobir, Jure; Manatakis, Dimitrios K.; Tasis, Nikolaos; Acheimastos, Vasileios; Ioannidis, Orestis; Loutzidou, Lydia; Symeonidis, Savvas; de Sá, Tiago Correia; Rocha, Mónica; Guagni, Tommaso; Pantalone, Desiré; Maltinti, Gherardo; Khokha, Vladimir; Abdel-elsalam, Wafaa; Ghoneim, Basma; López-Ruiz, José Antonio; Kara, Yasin; Zainudin, Syaza; Hayati, Firdaus; Azizan, Nornazirah; Khei, Victoria Tan Phooi; Yi, Rebecca Choy Xin; Sellappan, Harivinthan; Demetrashvili, Zaza; Lekiashvili, Nika; Tvaladze, Ana; Froiio, Caterina; Bernardi, Daniele; Bonavina, Luigi; Gil-Olarte, Angeles; Grassia, Sebastiano; Romero-Vargas, Estela; Bianco, Francesco; Gumbs, Andrew A.; Dogjani, Agron; Agresta, Ferdinando; Litvin, Andrey; Balogh, Zsolt J.; Gendrikson, George; Martino, Costanza; Damaskos, Dimitrios; Pararas, Nikolaos; Kirkpatrick, Andrew; Kurtenkov, Mikhail; Gomes, Felipe Couto; Pisanu, Adolfo; Nardello, Oreste; Gambarini, Fabrizio; Aref, Hager; Angelis, Nicola de'; Agnoletti, Vanni; Biondi, Antonio; Vacante, Marco; Griggio, Giulia; Tutino, Roberta; Massani, Marco; Bisetto, Giovanni; Occhionorelli, Savino; Andreotti, Dario; Lacavalla, Domenico; Biffl, Walter L.; Catena, Fausto
Source
World Journal of Emergency Surgery. December 16, 2022, Vol. 17 Issue 1
Subject
Language
English
ISSN
1749-7922
Abstract
Author(s): Belinda De Simone[sup.1], Fikri M. Abu-Zidan[sup.2], Elie Chouillard[sup.1], Salomone Di Saverio[sup.3], Massimo Sartelli[sup.4], Mauro Podda[sup.5], Carlos Augusto Gomes[sup.6], Ernest E. Moore[sup.7], Susan J. Moug[sup.8], Luca Ansaloni[sup.9], Yoram Kluger[sup.10], Federico [...]
Background The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands. Graphical abstract Keywords: Acute cholecystitis, Cholecystectomy, Gangrene, COVID-19, SARS-CoV-2, Laparoscopy, Surgery, Pandemic, Gangrenous cholecystitis
Background The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands. Graphical abstract Keywords: Acute cholecystitis, Cholecystectomy, Gangrene, COVID-19, SARS-CoV-2, Laparoscopy, Surgery, Pandemic, Gangrenous cholecystitis