Acute cholecystitis management at a tertiary care center: are we following current guidelines?

Autor: Spota A; Department of Surgery, University Health Network, 200 Elizabeth St 10 Eaton North, Room 216, Toronto, ON, M5G 2C4, Canada. a.spota89@gmail.com., Hassanpour A; Department of Surgery, University Health Network, 200 Elizabeth St 10 Eaton North, Room 216, Toronto, ON, M5G 2C4, Canada., Shlomovitz E; Department of General Surgery, Department of Vascular Interventional Radiology, University Health Network, Toronto, ON, Canada.; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Gomez D; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.; Department of Surgery, St. Michael's Hospital- Unity Health, Toronto, ON, Canada., Al-Sukhni E; Department of Surgery, University Health Network, 200 Elizabeth St 10 Eaton North, Room 216, Toronto, ON, M5G 2C4, Canada.; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Jazyk: angličtina
Zdroj: Langenbeck's archives of surgery [Langenbecks Arch Surg] 2024 Oct 24; Vol. 409 (1), pp. 323. Date of Electronic Publication: 2024 Oct 24.
DOI: 10.1007/s00423-024-03510-w
Abstrakt: Purpose: After the Tokyo 2018 guidelines (TG2018) were published, evidence from the 2018 CHOCOLATE RCT supported early cholecystectomy for acute cholecystitis (AC), even in high-risk patients. This study aims to investigate AC management at our tertiary care center in the years following these publications.
Methods: A retrospective cohort study was performed on patients admitted from 2018 to 2023. AC severity was graded using TG2018 definitions. Comorbidities were summarized using Charlson Comorbidity Index (CCI) and frailty using the 5-item modified Frailty Index (5mFI). Compliance with TG2018 recommendations for management strategy was investigated. Outcomes were compared between patients who underwent surgery versus non-operative management (NOM). Subset analysis based on patients' age, frailty, and comorbidities was performed.
Results: Among 642 AC patients, 57% underwent cholecystectomy and 43% NOM (22% percutaneous cholecystostomy, 21% antibiotics only). NOM patients had greater length of stay (LOS), complications, deaths, readmissions, and discharge to nursing/rehab versus surgery patients. In 70% of patients managed non-operatively, TG2018 were not followed. Patients managed non-operatively despite TG2018 were more likely to undergo delayed cholecystectomy compared to those in whom guidelines were followed (17% vs. 4%). In subset analysis, healthy octogenarians were significantly less likely to be managed according to TG2018 (9.4%); patients undergoing surgery had a trend towards shorter LOS (3.1 vs. 4.8 days) than those managed non-operatively but no difference in other outcomes.
Conclusion: Most patients undergoing NOM could potentially undergo cholecystectomy if guidelines are considered. A more objective approach to risk assessment may optimize patient selection and outcomes.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: