Predictive factors for the type of surgery in acute cholecystitis.

Details

Serval ID
serval:BIB_50486270D2E0
Type
Article: article from journal or magazin.
Collection
Publications
Title
Predictive factors for the type of surgery in acute cholecystitis.
Journal
American journal of surgery
Author(s)
Schäfer M., Krähenbühl L., Büchler M.W.
ISSN
0002-9610 (Print)
ISSN-L
0002-9610
Publication state
Published
Issued date
09/2001
Peer-reviewed
Oui
Volume
182
Number
3
Pages
291-297
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Whereas early cholecystectomy is accepted as the optimal timing for surgery, the best treatment modality for acute cholecystitis (AC) is still under debate. In this series, we aimed to assess the current treatment of AC in a single institution. In addition, preoperative criteria were defined predicting the severity of inflammation.
From January 1995 to June 1999, 236 patients undergoing cholecystectomy for AC were prospectively evaluated. Outcome measures were the treatment modality, the severity of inflammation, white blood cell (WBC) count, C-reactive protein (CRP), morbidity, and hospital stay.
There were 115 laparoscopic cholecystectomies (LC), 77 primary open cholecystectomies (OC), and 44 conversions (CON) to OC. Patients with LC were significantly younger, in better condition, with a shorter duration of symptoms and lower CRP levels and WBC counts compared with OC and CON (P <0.001). Postoperative complications, reinterventions, and mean hospital stay were significantly increased after OC and CON (P <0.001). Overall mortality was 2.5%. Advanced AC was predominantly found in OC and CON (P <0.001). Patients with advanced AC were significantly older, predominantly male, and had a prolonged duration of symptoms as well as increased CRP levels and WBC counts (P <0.001). The conversion rate increased from 10% for mild AC up to 48% for necrotizing AC.
Based on laboratory (CRP, WBC), demographic (age, sex), and individual (American Society of Anesthesiologists classification, duration of symptoms) findings, it is possible to reliably predict the severity of inflammation. Therefore, an individualized surgical approach can be used for each patient and type of AC.
Keywords
Acute Disease, Adult, Aged, Aged, 80 and over, C-Reactive Protein/analysis, Cholecystectomy, Cholecystectomy, Laparoscopic, Cholecystitis/mortality, Cholecystitis/surgery, Emergencies, Female, Humans, Length of Stay, Leukocyte Count, Male, Middle Aged, Prospective Studies, Severity of Illness Index
Pubmed
Web of science
Create date
11/12/2018 15:02
Last modification date
20/08/2019 15:06
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