Outcome Analysis of Conservative Management of Acute Calculus Cholecystitis in Addis Ababa University Teaching Hospitals Addis Ababa, Ethiopia: Retrospective Study

Abstract

: Back ground: cholecystectomy for an acutely inflamed gall bladder is accompanied with significant perioperative complications Conservative (non operative management) is considered to be the standard of care mainly in the developed world . Non operative management is still widely practiced in many developing countries including Ethiopia. This study aimed to assess the outcome of such a conservative management in teaching hospitals Addis Ababa, Ethiopia. Method: Hospital based cross-sectional study design was conducted. Data was entered and analyzed by SPSS version 20. Chi-square, binary logistic regression, at 95% CI and P-value <0.05 were used to examine relationship between dependent and independent variables. Results: A total of 134 cases were admitted. In this study the mean age is 41.67, (95% CI 39.5 to 43.9) and M: F ratio is 1:2.2 and Age of the patients ranged between 15-80 years and majority of them were in the age group of 35-44 (32.1%) years. Conservative treatment during index admission was successful in 96.27% of the cases but mean duration of hospital stay 5.54 days, 95% CI (5.03, 6.05) . Duration of illness before (OR = 3.47: 1.26-9.55 ) and Duration of hospital stay (OR = 1.92: 1.28-2.87) were determinant factors for index admission. 19% of patients encountered complication while waiting for cholecystectomy. Comorbidity ( AOR = 4.06: 1.49 - 11.07; value = 0.006 ). GB stone impacted at the neck ( AOR = 3.39: (1.259-9.13); value = 0.016) were associated factors identified. In this study out of 131 cases treated and discharged improved and appointed for interval-cholecystectomy only 71.7% of them had interval -cholecystectomy in two-year period. The rest 13 (9.7%) patients did not show up follow up after admission booked (registered under waiting list for bed). 3 patients died with complications directly or indirectly related to conservative management cholecystitis. Conclusion and Recommendations : this study revealed patients arrival to hospital is delayed and also stayed prolonged time in the hospital. significant number of patients also developed complications while waiting for interval cholecystectomy and also significant Number of patients did not get cholecystectomy service. Nationwide introduction of emergency laparoscopic cholecystectomy and Patient referral system, admission, discharge and follow up system needs revision.