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. 2021 Nov;25(11):2814-2822.
doi: 10.1007/s11605-021-04956-9. Epub 2021 Feb 24.

How to Predict Postoperative Complications After Early Laparoscopic Cholecystectomy for Acute Cholecystitis: the Chole-Risk Score

Marcello Di Martino  1 , Ismael Mora-Guzmán  2   3 , Víctor Vaello Jodra  4 , Alfonso Sanjuanbenito Dehesa  4 , Dieter Morales García  5 , Rubén Caiña Ruiz  5 , Francisca García-Moreno Nisa  6 , Fernando Mendoza Moreno  6 , Sara Alonso Batanero  7 , José Edecio Quiñones Sampedro  7 , Paola Lora Cumplido  8 , Altea Arango Bravo  6 , Ines Rubio-Perez  9 , Luis Asensio-Gomez  9 , Fernando Pardo Aranda  10 , Sara Sentí Farrarons  10 , Cristina Ruiz Moreno  11 , Clara Maria Martinez Moreno  11 , Aingeru Sarriugarte Lasarte  12 , Mikel Prieto Calvo  12 , Daniel Aparicio-Sánchez  13 , Eduardo Perea Del Pozo  13 , Gianluca Pellino  14   15 , Elena Martin-Perez  2
Affiliations

How to Predict Postoperative Complications After Early Laparoscopic Cholecystectomy for Acute Cholecystitis: the Chole-Risk Score

Marcello Di Martino et al. J Gastrointest Surg. 2021 Nov.

Abstract

Background: Early laparoscopic cholecystectomy (ELC) is the gold standard treatment for patients with acute calculous cholecystitis (ACC); however, it is still related to significant postoperative complications. The aim of this study is to identify factors associated with an increased risk of postoperative complications and develop a preoperative score able to predict them.

Methods: Multicentric retrospective analysis of 1868 patients with ACC submitted to ELC. Included patients were divided into two groups according to the presentation of increased postoperative complications defined as postoperative complications ≥ Clavien-Dindo IIIa, length of stay greater than 10 days and readmissions within 30 days of discharge. Variables that were independently predictive of increased postoperative complications were combined determining the Chole-Risk Score, which was validated through a correlation analysis.

Results: We included 282 (15.1%) patients with postoperative complications. The multivariate analysis predictors of increased morbidity were previous percutaneous cholecystostomy (OR 2.95, p=0.001), previous abdominal surgery (OR 1.57, p=0.031) and diabetes (OR 1.62, p=0.005); Charlson Comorbidity Index >6 (OR 2.48, p=0.003), increased total bilirubin > 2 mg/dL (OR 1.88, p=0.002), dilated bile duct (OR 1.79, p=0.027), perforated gallbladder (OR 2.62, p<0.001) and severity grade (OR 1.93, p=0.001). The Chole-Risk Score was generated by grouping these variables into four categories, with scores ranging from 0 to 4. It presented a progressive increase in postoperative complications ranging from 5.8% of patients scoring 0 to 47.8% of patients scoring 4 (p<0.001).

Conclusion: The Chole-Risk Score represents an intuitive tool capable of predicting postoperative complications in patients with ACC.

Keywords: cholecystectomy; cholecystitis; early laparoscopic cholecystectomy; postoperative complication.

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References

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