Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study

• Published in: World journal of emergency surgery 2023-03, Vol.18 (1), p.20-20, Article 20
• Main Authors: Fugazzola, Paola, Cobianchi, Lorenzo, Di Martino, Marcello, Tomasoni, Matteo, Dal Mas, Francesca, Abu-Zidan, Fikri M, Agnoletti, Vanni, Ceresoli, Marco, Coccolini, Federico, Di Saverio, Salomone, Dominioni, Tommaso, Farè, Camilla Nikita, Frassini, Simone, Gambini, Giulia, Leppäniemi, Ari, Maestri, Marcello, Martín-Pérez, Elena, Moore, Ernest E, Musella, Valeria, Peitzman, Andrew B, de la Hoz Rodríguez, Ángela, Sargenti, Benedetta, Sartelli, Massimo, Viganò, Jacopo, Anderloni, Andrea, Biffl, Walter, Catena, Fausto, Ansaloni, Luca
• Format: Article
• Language: English
• Subjects: Acute cholecystitis; Bile ducts; Cholecystectomy; Cholecystitis; Comorbidity; Comparative analysis; Contraindications; Gallbladder; Gallbladder diseases; Gallstones; Greece; Hospitals; Humans; Missing data; Morbidity; Mortality; Observational studies; Patient outcomes; Patients; Physiology; POSSUM; Prospective Studies; Risk assessment; Risk Assessment - methods; Spain; Surgery; Surgical risk; Taiwan
• ISSN: 1749-7922; 1749-7922
• DOI: 10.1186/s13017-023-00488-6

Less invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models. The S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models-POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade-receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities. A 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p