TY - JOUR
T1 - Predicting gangrenous cholecystitis
AU - Wu, Bin
AU - Buddensick, Thomas J.
AU - Ferdosi, Hamid
AU - Narducci, Dusty Marie
AU - Sautter, Amanda
AU - Setiawan, Lisa
AU - Shaukat, Haroon
AU - Siddique, Mustafa
AU - Sulkowski, Gisela N.
AU - Kamangar, Farin
AU - Kowdley, Gopal C.
AU - Cunningham, Steven C.
PY - 2014/9
Y1 - 2014/9
N2 - Background Gangrenous cholecystitis (GC) is often challenging to treat. The objectives of this study were to determine the accuracy of pre-operative diagnosis, to assess the rate of post-cholecystectomy complications and to assess models to predict GC. Methods A retrospective single-institution review identified patients undergoing a cholecystectomy. Logistic regression models were used to examine the association of variables with GC and to build risk-assessment models. Results Of 5812 patients undergoing a cholecystectomy, 2219 had acute, 4837 chronic and 351 GC. Surgeons diagnosed GC pre-operatively in only 9% of cases. Patients with GC had more complications, including bile-duct injury, increased estimated blood loss (EBL) and more frequent open cholecystectomies. In unadjusted analyses, variables significantly associated with GC included: age >45 years, male gender, heart rate (HR) >90, white blood cell count (WBC) >13000/mm3, gallbladder wall thickening (GBWT) ≥ 4mm, pericholecystic fluid (PCCF) and American Society of Anesthesiology (ASA) >2. In adjusted analyses, age, WBC, GBWT and HR, but not gender, PCCF or ASA remained statistically significant. A 5-point scoring system was created: 0 points gave a 2% probability of GC and 5 points a 63% probability. Conclusion Using models can improve a diagnosis of GC pre-operatively. A prediction of GC pre-operatively may allow surgeons to be better prepared for a difficult operation.
AB - Background Gangrenous cholecystitis (GC) is often challenging to treat. The objectives of this study were to determine the accuracy of pre-operative diagnosis, to assess the rate of post-cholecystectomy complications and to assess models to predict GC. Methods A retrospective single-institution review identified patients undergoing a cholecystectomy. Logistic regression models were used to examine the association of variables with GC and to build risk-assessment models. Results Of 5812 patients undergoing a cholecystectomy, 2219 had acute, 4837 chronic and 351 GC. Surgeons diagnosed GC pre-operatively in only 9% of cases. Patients with GC had more complications, including bile-duct injury, increased estimated blood loss (EBL) and more frequent open cholecystectomies. In unadjusted analyses, variables significantly associated with GC included: age >45 years, male gender, heart rate (HR) >90, white blood cell count (WBC) >13000/mm3, gallbladder wall thickening (GBWT) ≥ 4mm, pericholecystic fluid (PCCF) and American Society of Anesthesiology (ASA) >2. In adjusted analyses, age, WBC, GBWT and HR, but not gender, PCCF or ASA remained statistically significant. A 5-point scoring system was created: 0 points gave a 2% probability of GC and 5 points a 63% probability. Conclusion Using models can improve a diagnosis of GC pre-operatively. A prediction of GC pre-operatively may allow surgeons to be better prepared for a difficult operation.
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U2 - 10.1111/hpb.12226
DO - 10.1111/hpb.12226
M3 - Article
C2 - 24635779
AN - SCOPUS:84905756718
SN - 1365-182X
VL - 16
SP - 801
EP - 806
JO - HPB
JF - HPB
IS - 9
ER -