Illés Tóth, Ria Benkő, Mária Matuz, Dániel Váczi, László Andrási, László Libor, János Tajti, György Lázár, Szabolcs Ábrahám
{"title":"Evaluating Surgical Outcomes in Acute Cholecystectomies.","authors":"Illés Tóth, Ria Benkő, Mária Matuz, Dániel Váczi, László Andrási, László Libor, János Tajti, György Lázár, Szabolcs Ábrahám","doi":"10.4293/JSLS.2024.00061","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>This study aimed to identify the predictors of surgical outcomes in acute cholecystitis (AC).</p><p><strong>Methods: </strong>Patients undergoing cholecystectomy for AC between January 1, 2007 and December 31, 2019 at a single center were retrospectively reviewed. Conversion rate (CR), laparoscopic success rate (LSR), mortality, and bile duct injury (BDI) were evaluated in light of sex, age, ultrasound morphological diagnoses, severity of cholecystitis, performance status, time frame, and introduction of percutaneous transhepatic gallbladder drainage (PTGBD).</p><p><strong>Results: </strong>A total of 465 patients underwent early cholecystectomy. CR and LSR were 16.89% and 78.28%, respectively; the mortality rate was 1.62%. Increased severity of cholecystitis (grade I vs II vs III) was associated with increased mortality (1.17 vs 2.27 vs 8.33%, <i>P</i> = .183) and CR (7.09 vs 32.93 vs 28.57%, <i>P</i> < .001) and decreased LSR (91.11 vs 61.11 vs 38.46%, <i>P</i> < .001). Surgery within 72 hours had lower mortality (1.41 vs 2.6%, <i>P</i> = .613) with significantly lower CR (14.45 vs 25.71%, <i>P</i> = .008) and higher LSR (81.69 vs 67.53%, <i>P</i> = .008) compared to surgery after 72 hours. Mortality (0 vs 0.92 vs 6.19%, <i>P</i> = .001) and CR (4.2 vs 16.27 vs 39.53%, <i>P</i> < .001) increased with an increase in Charlson comorbidity index (CCI), while LSR decreased (95.8 vs 79.91 vs 50.49%, <i>P</i> < .001).</p><p><strong>Conclusion: </strong>CCI and the severity of cholecystitis had the strongest influence on CR and LSR. Cholecystectomies performed within 72 hours were associated with reduced CR and increased LSR. PTGBD is a viable treatment option in elderly high-risk patients.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 1","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975552/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4293/JSLS.2024.00061","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/8 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and objectives: This study aimed to identify the predictors of surgical outcomes in acute cholecystitis (AC).
Methods: Patients undergoing cholecystectomy for AC between January 1, 2007 and December 31, 2019 at a single center were retrospectively reviewed. Conversion rate (CR), laparoscopic success rate (LSR), mortality, and bile duct injury (BDI) were evaluated in light of sex, age, ultrasound morphological diagnoses, severity of cholecystitis, performance status, time frame, and introduction of percutaneous transhepatic gallbladder drainage (PTGBD).
Results: A total of 465 patients underwent early cholecystectomy. CR and LSR were 16.89% and 78.28%, respectively; the mortality rate was 1.62%. Increased severity of cholecystitis (grade I vs II vs III) was associated with increased mortality (1.17 vs 2.27 vs 8.33%, P = .183) and CR (7.09 vs 32.93 vs 28.57%, P < .001) and decreased LSR (91.11 vs 61.11 vs 38.46%, P < .001). Surgery within 72 hours had lower mortality (1.41 vs 2.6%, P = .613) with significantly lower CR (14.45 vs 25.71%, P = .008) and higher LSR (81.69 vs 67.53%, P = .008) compared to surgery after 72 hours. Mortality (0 vs 0.92 vs 6.19%, P = .001) and CR (4.2 vs 16.27 vs 39.53%, P < .001) increased with an increase in Charlson comorbidity index (CCI), while LSR decreased (95.8 vs 79.91 vs 50.49%, P < .001).
Conclusion: CCI and the severity of cholecystitis had the strongest influence on CR and LSR. Cholecystectomies performed within 72 hours were associated with reduced CR and increased LSR. PTGBD is a viable treatment option in elderly high-risk patients.
背景和目的:本研究旨在确定急性胆囊炎(AC)手术预后的预测因素。方法:回顾性分析2007年1月1日至2019年12月31日在单中心接受胆囊切除术的AC患者。根据性别、年龄、超声形态学诊断、胆囊炎严重程度、表现状态、时间框架、引入经皮经肝胆囊引流术(PTGBD)等因素评估转化率(CR)、腹腔镜成功率(LSR)、死亡率和胆管损伤(BDI)。结果:465例患者接受了早期胆囊切除术。CR和LSR分别为16.89%和78.28%;死亡率为1.62%。胆囊炎严重程度的增加(I级vs II级vs III级)与死亡率(1.17 vs 2.27 vs 8.33%, P = .183)和CR (7.09 vs 32.93 vs 28.57%, P P = .613)相关,与72小时后手术相比,CR (14.45 vs 25.71%, P = .008)和LSR (81.69 vs 67.53%, P = .008)显著降低。死亡率(0 vs 0.92 vs 6.19%, P = .001)和CR (4.2 vs 16.27 vs 39.53%, P = .001)结论:CCI和胆囊炎严重程度对CR和LSR影响最大。在72小时内进行胆囊切除术与CR降低和LSR增加相关。PTGBD是老年高危患者可行的治疗选择。
期刊介绍:
JSLS, Journal of the Society of Laparoscopic & Robotic Surgeons publishes original scientific articles on basic science and technical topics in all the fields involved with laparoscopic, robotic, and minimally invasive surgery. CRSLS, MIS Case Reports from SLS is dedicated to the publication of Case Reports in the field of minimally invasive surgery. The journals seek to advance our understandings and practice of minimally invasive, image-guided surgery by providing a forum for all relevant disciplines and by promoting the exchange of information and ideas across specialties.