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Observational Study
. 2022 Dec 16;17(1):61.
doi: 10.1186/s13017-022-00466-4.

The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

Belinda De Simone  1 , Fikri M Abu-Zidan  2 , Elie Chouillard  3 , Salomone Di Saverio  4 , Massimo Sartelli  5 , Mauro Podda  6 , Carlos Augusto Gomes  7 , Ernest E Moore  8 , Susan J Moug  9 , Luca Ansaloni  10 , Yoram Kluger  11 , Federico Coccolini  12 , Aitor Landaluce-Olavarria  13 , Begoña Estraviz-Mateos  13 , Ana Uriguen-Etxeberria  13 , Alessio Giordano  14 , Alfonso Palmieri Luna  15 , Luz Adriana Hernández Amín  15 , Adriana María Palmieri Hernández  15 , Amanda Shabana  16 , Zakaria Andee Dzulkarnaen  17 , Muhammad Asyraf Othman  17 , Mohamad Ikhwan Sani  17 , Andrea Balla  18 , Rosa Scaramuzzo  18 , Pasquale Lepiane  18 , Andrea Bottari  19 , Fabio Staderini  19 , Fabio Cianchi  19 , Andrea Cavallaro  20 , Antonio Zanghì  20 , Alessandro Cappellani  20 , Roberto Campagnacci  21 , Angela Maurizi  21 , Mario Martinotti  22 , Annamaria Ruggieri  22 , Asri Che Jusoh  23 , Karim Abdul Rahman  23 , Anis Suraya M Zulkifli  23 , Barbara Petronio  24 , Belén Matías-García  25 , Ana Quiroga-Valcárcel  25 , Fernando Mendoza-Moreno  25 , Boyko Atanasov  26 , Fabio Cesare Campanile  27 , Ilaria Vecchioni  27 , Luca Cardinali  28 , Grazia Travaglini  28 , Elisa Sebastiani  28 , Serge Chooklin  29 , Serhii Chuklin  29 , Pasquale Cianci  30 , Enrico Restini  30 , Sabino Capuzzolo  30 , Giuseppe Currò  31 , Rosalinda Filippo  31 , Michele Rispoli  31 , Daniel Aparicio-Sánchez  32 , Virginia Durán Muñóz-Cruzado  32 , Sandra Dios Barbeito  32 , Samir Delibegovic  33 , Amar Kesetovic  33 , Diego Sasia  34 , Felice Borghi  34 , Giorgio Giraudo  34 , Diego Visconti  35 , Emanuele Doria  35 , Mauro Santarelli  35 , Davide Luppi  36 , Stefano Bonilauri  36 , Ugo Grossi  37 , Giacomo Zanus  37 , Alberto Sartori  38 , Giacomo Piatto  38 , Maurizio De Luca  38 , Domenico Vita  37 , Luigi Conti  39 , Patrizio Capelli  39 , Gaetano Maria Cattaneo  39 , Athanasios Marinis  40 , Styliani-Aikaterini Vederaki  40 , Mehmet Bayrak  41 , Yasemin Altıntas  42 , Mustafa Yener Uzunoglu  43 , Iskender Eren Demirbas  43 , Yuksel Altinel  44 , Serhat Meric  44 , Yunus Emre Aktimur  44 , Derya Salim Uymaz  45 , Nail Omarov  45 , Ibrahim Azamat  45 , Eftychios Lostoridis  46 , Eleni-Aikaterini Nagorni  46 , Antonio Pujante  46 , Gabriele Anania  47 , Cristina Bombardini  47 , Francesco Bagolini  47 , Emre Gonullu  48 , Baris Mantoglu  48 , Recayi Capoglu  48 , Stefano Cappato  49 , Elena Muzio  49 , Elif Colak  50 , Suleyman Polat  50 , Zehra Alan Koylu  50 , Fatih Altintoprak  51 , Zülfü Bayhan  51 , Emrah Akin  51 , Enrico Andolfi  52 , Sulce Rezart  52 , Jae Il Kim  53 , Sung Won Jung  53 , Yong Chan Shin  53 , Octavian Enciu  54 , Elena Adelina Toma  54 , Fabio Medas  6 , Gian Luigi Canu  6 , Federico Cappellacci  6 , Fabrizio D'Acapito  55 , Giorgio Ercolani  55 , Leonardo Solaini  55 , Francesco Roscio  56 , Federico Clerici  56 , Roberta Gelmini  57 , Francesco Serra  57 , Elena Giulia Rossi  57 , Francesco Fleres  58 , Guglielmo Clarizia  58 , Alessandro Spolini  58 , Francesco Ferrara  59 , Gabriela Nita  60 , Jlenia Sarnari  60 , Mahir Gachabayov  61 , Abakar Abdullaev  61 , Gaetano Poillucci  62 , Gian Marco Palini  63 , Simone Veneroni  63 , Gianluca Garulli  63 , Micaela Piccoli  64 , Gianmaria Casoni Pattacini  64 , Francesca Pecchini  64 , Giulio Argenio  65 , Mariano Fortunato Armellino  65 , Giuseppe Brisinda  66 , Silvia Tedesco  66 , Pietro Fransvea  66 , Giuseppe Ietto  67 , Caterina Franchi  67 , Giulio Carcano  67 , Gennaro Martines  68 , Giuseppe Trigiante  68 , Giulia Negro  68 , Gustavo Machain Vega  69 , Agustín Rodríguez González  69 , Leonardo Ojeda  69 , Gaetano Piccolo  70 , Andrea Bondurri  71 , Anna Maffioli  71 , Claudio Guerci  71 , Boo Han Sin  72 , Zamri Zuhdi  72 , Azlanudin Azman  72 , Hussam Mousa  73 , Shadi Al Bahri  73 , Goran Augustin  74 , Ivan Romic  74 , Trpimir Moric  74 , Ioannis Nikolopoulos  75 , Jacopo Andreuccetti  76 , Giusto Pignata  76 , Rossella D'Alessio  76 , Jakub Kenig  77 , Urszula Skorus  77 , Gustavo Pereira Fraga  78 , Elcio Shiyoiti Hirano  78 , Jackson Vinícius de Lima Bertuol  79 , Arda Isik  80 , Eray Kurnaz  80 , Mohammad Sohail Asghar  81 , Ameer Afzal  81 , Ali Akbar  81 , Taxiarchis Konstantinos Nikolouzakis  82 , Konstantinos Lasithiotakis  82 , Emmanuel Chrysos  82 , Koray Das  83 , Nazmi Özer  83 , Ahmet Seker  83 , Mohamed Ibrahim  84 , Hytham K S Hamid  84 , Ahmed Babiker  84 , Konstantinos Bouliaris  85 , George Koukoulis  85 , Chrysoula-Christina Kolla  85 , Andrea Lucchi  86 , Laura Agostinelli  86 , Antonio Taddei  87 , Laura Fortuna  87 , Carlotta Agostini  87 , Leo Licari  88 , Simona Viola  89 , Cosimo Callari  90 , Letizia Laface  91 , Emmanuele Abate  91 , Massimiliano Casati  91 , Alessandro Anastasi  92 , Giuseppe Canonico  92 , Linda Gabellini  92 , Lorenzo Tosi  93 , Anna Guariniello  94 , Federico Zanzi  94 , Lovenish Bains  95 , Larysa Sydorchuk  96 , Oksana Iftoda  96 , Andrii Sydorchuk  96 , Michele Malerba  97 , Federico Costanzo  97 , Raffaele Galleano  97 , Michela Monteleone  98 , Andrea Costanzi  98 , Carlo Riva  98 , Maciej Walędziak  99 , Andrzej Kwiatkowski  99 , Łukasz Czyżykowski  99 , Piotr Major  100 , Marcin Strzałka  100 , Maciej Matyja  100 , Michal Natkaniec  100 , Maria Rosaria Valenti  101 , Maria Domenica Pia Di Vita  101 , Maria Sotiropoulou  102 , Stylianos Kapiris  102 , Damien Massalou  103 , Massimiliano Veroux  104 , Alessio Volpicelli  104 , Rossella Gioco  104 , Matteo Uccelli  105 , Marta Bonaldi  105 , Stefano Olmi  105 , Matteo Nardi  106 , Giada Livadoti  106 , Cristian Mesina  107 , Theodor Viorel Dumitrescu  107 , Mihai Calin Ciorbagiu  107 , Michele Ammendola  108 , Giorgio Ammerata  108 , Roberto Romano  108 , Mihail Slavchev  109 , Evangelos P Misiakos  110 , Emmanouil Pikoulis  110 , Dimitrios Papaconstantinou  110 , Mohamed Elbahnasawy  111 , Sherief Abdel-Elsalam  112 , Daniel M Felsenreich  113 , Julia Jedamzik  113 , Nikolaos V Michalopoulos  114 , Theodoros A Sidiropoulos  114 , Maria Papadoliopoulou  114 , Nicola Cillara  115 , Antonello Deserra  115 , Alessandro Cannavera  115 , Ionuţ Negoi  116 , Dimitrios Schizas  117 , Athanasios Syllaios  117 , Ilias Vagios  117 , Stavros Gourgiotis  118 , Nick Dai  118 , Rekha Gurung  118 , Marcus Norrey  118 , Antonio Pesce  119 , Carlo Vittorio Feo  119 , Nicolo' Fabbri  119 , Nikolaos Machairas  120 , Panagiotis Dorovinis  120 , Myrto D Keramida  120 , Francesk Mulita  121 , Georgios Ioannis Verras  121 , Michail Vailas  121 , Omer Yalkin  122 , Nidal Iflazoglu  122 , Direnc Yigit  122 , Oussama Baraket  123 , Karim Ayed  123 , Mohamed Hedi Ghalloussi  123 , Parmenion Patias  124 , Georgios Ntokos  124 , Razrim Rahim  125 , Miklosh Bala  126 , Asaf Kedar  126 , Robert G Sawyer  127 , Anna Trinh  127 , Kelsey Miller  127 , Ruslan Sydorchuk  128 , Ruslan Knut  128 , Oleksandr Plehutsa  128 , Rumeysa Kevser Liman  129 , Zeynep Ozkan  129 , Saleh Abdel Kader  130 , Sanjay Gupta  131 , Monika Gureh  131 , Sara Saeidi  132 , Mohsen Aliakbarian  132 , Amin Dalili  132 , Tomohisa Shoko  133 , Mitsuaki Kojima  133 , Raira Nakamoto  133 , Semra Demirli Atici  134 , Gizem Kilinc Tuncer  134 , Tayfun Kaya  134 , Spiros G Delis  135 , Stefano Rossi  136 , Biagio Picardi  136 , Simone Rossi Del Monte  136 , Tania Triantafyllou  137 , Dimitrios Theodorou  137 , Tadeja Pintar  138 , Jure Salobir  138 , Dimitrios K Manatakis  139 , Nikolaos Tasis  139 , Vasileios Acheimastos  139 , Orestis Ioannidis  140 , Lydia Loutzidou  140 , Savvas Symeonidis  140 , Tiago Correia de Sá  141 , Mónica Rocha  141 , Tommaso Guagni  142 , Desiré Pantalone  142 , Gherardo Maltinti  142 , Vladimir Khokha  143 , Wafaa Abdel-Elsalam  144 , Basma Ghoneim  144 , José Antonio López-Ruiz  145 , Yasin Kara  146 , Syaza Zainudin  147 , Firdaus Hayati  147 , Nornazirah Azizan  147 , Victoria Tan Phooi Khei  148 , Rebecca Choy Xin Yi  148 , Harivinthan Sellappan  148 , Zaza Demetrashvili  149 , Nika Lekiashvili  149 , Ana Tvaladze  149 , Caterina Froiio  150 , Daniele Bernardi  150 , Luigi Bonavina  150 , Angeles Gil-Olarte  145 , Sebastiano Grassia  151 , Estela Romero-Vargas  145 , Francesco Bianco  151 , Andrew A Gumbs  3 , Agron Dogjani  152 , Ferdinando Agresta  153 , Andrey Litvin  154 , Zsolt J Balogh  155 , George Gendrikson  154 , Costanza Martino  156 , Dimitrios Damaskos  157 , Nikolaos Pararas  158 , Andrew Kirkpatrick  159 , Mikhail Kurtenkov  154 , Felipe Couto Gomes  7 , Adolfo Pisanu  6 , Oreste Nardello  6 , Fabrizio Gambarini  22 , Hager Aref  3 , Nicola De' Angelis  160 , Vanni Agnoletti  161 , Antonio Biondi  162 , Marco Vacante  162 , Giulia Griggio  162 , Roberta Tutino  163 , Marco Massani  163 , Giovanni Bisetto  164 , Savino Occhionorelli  165 , Dario Andreotti  165 , Domenico Lacavalla  165 , Walter L Biffl  166 , Fausto Catena  161
Affiliations
Observational Study

The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

Belinda De Simone et al. World J Emerg Surg. .

Abstract

Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not.

Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not.

Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001].

Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.

Keywords: Acute cholecystitis; COVID-19; Cholecystectomy; Gangrene; Gangrenous cholecystitis; Laparoscopy; Pandemic; SARS-CoV-2; Surgery.

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Conflict of interest statement

Authors have no competing interests for this study.

Figures

Fig. 1
Fig. 1
Box-and-whiskers plot of severity markers WSES score (A), PIPAS score (B), and qSOFA score (C), comparing the COVID and the non-COVID patients who were globally treated for acute cholecystitis in 42 countries from 234 centers over the period October 2020–April 2021. The box resembles the 25th percentile and the 75th percentile interquartile range (IQR), while the line within the box resembles the median. p value = Mann–Whitney U test
Fig. 2
Fig. 2
Box-and-whiskers plot of Clavien-Dindo postoperative complication classification comparing the COVID and the non-COVID patients. The box resembles the 25th percentile and the 75th percentile interquartile range (IQR), while the line within the box resembles the median. p value = Mann–Whitney U test
Fig. 3
Fig. 3
Box-and-whiskers plot of gall bladder wall thickness (mm) in the COVID and the non-COVID patients who had total or partial cholecystectomy. The box resembles the 25th percentile and the 75th percentile interquartile range (IQR), while the line within the box resembles the median. p value = Mann–Whitney U test
See this image and copyright information in PMC

References

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