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Observational Study
. 2023 Mar 18;18(1):20.
doi: 10.1186/s13017-023-00488-6.

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

Paola Fugazzola  1 , Lorenzo Cobianchi  2   3 , Marcello Di Martino  4 , Matteo Tomasoni  1 , Francesca Dal Mas  5 , Fikri M Abu-Zidan  6 , Vanni Agnoletti  7 , Marco Ceresoli  8 , Federico Coccolini  9 , Salomone Di Saverio  10 , Tommaso Dominioni  1 , Camilla Nikita Farè  1 , Simone Frassini  1 , Giulia Gambini  11 , Ari Leppäniemi  12 , Marcello Maestri  1 , Elena Martín-Pérez  13 , Ernest E Moore  14 , Valeria Musella  11 , Andrew B Peitzman  15 , Ángela de la Hoz Rodríguez  13 , Benedetta Sargenti  1 , Massimo Sartelli  16 , Jacopo Viganò  1 , Andrea Anderloni  17 , Walter Biffl  18 , Fausto Catena  19 , Luca Ansaloni  1   20 ; S.P.Ri.M.A.C.C. Collaborative Group
Collaborators, Affiliations
Observational Study

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

Paola Fugazzola et al. World J Emerg Surg. .

Abstract

Background: 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.

Method: 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.

Results: 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 < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a 'Chole-POSSUM' score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96-97% negative predictive value for major complications.

Conclusions: The Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action.

Trial registration: ClinicalTrial.gov NCT04995380.

Keywords: Acute cholecystitis; Cholecystectomy; POSSUM; Surgical risk.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Patients geographical distribution according to S.P.Ri.M.A.C.C. participants
Fig. 2
Fig. 2
ROC curves of POSSUM physiological score, Acute Calcolous Cholecystitis (ACC) severity grade (according to the 2018 Tokyo Guidelines), Charlson Comorbidity index, ASA-PS, Chole-risk, modified Frailty Index, APACHE II for in-hospital mortality (a), 30-day mortality (b), in-hospital major morbidity (c), 30-day major morbidity (d) in patients with ACC after EC
Fig. 3
Fig. 3
ROC curves of POSSUM Physiological Score of the derivation and validation groups for in-hospital mortality (a), 30-day mortality (b), in-hospital major morbidity (c), 30-day major morbidity (d)in patients with ACC after EC
See this image and copyright information in PMC

References

    1. Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S, Boerna D, et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020;15(1):1–26. doi: 10.1186/s13017-020-00336-x. - DOI - PMC - PubMed
    1. Miura F, Takada T, Kawarada Y, Nimura Y, Wada K, Hirota M, et al. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):27–34. doi: 10.1007/s00534-006-1153-x. - DOI - PMC - PubMed
    1. Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos) J Hepatobiliary Pancreat Sci. 2013;20(1):35–46. doi: 10.1007/s00534-012-0568-9. - DOI - PubMed
    1. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos) J Hepatobiliary Pancreat Sci. 2018;25(1):41–54. doi: 10.1002/jhbp.515. - DOI - PubMed
    1. Ansaloni L, Pisano M, Coccolini F, Peitzmann AB, Fingerhut A, Catena F, et al. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg. 2016;11(1):1–23. - PMC - PubMed

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