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Moulton A, Liu JK, Miguel de Virgilio C, Ozao-Choy J, Moazzez A. The Impact of Postoperative COVID-19 Infection on 30-day Outcomes of Laparoscopic Cholecystectomy. Am Surg 2024; 90:2514-2521. [PMID: 38655851 DOI: 10.1177/00031348241248800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Introduction: Preoperative Coronavirus Disease 2019 (COVID-19) infections are associated with postoperative adverse outcomes. However, there is limited data on the impact of postoperative COVID-19 infection on postoperative outcomes of common general surgery procedures.Objective: To evaluate the impact of postoperative COVID-19 diagnosis on laparoscopic cholecystectomy outcomes.Methods: Patients with symptomatic cholelithiasis, acute cholecystitis, or gallstone pancreatitis who underwent laparoscopic cholecystectomy with or without intraoperative cholangiogram were identified using the 2021 National Surgical Quality Improvement Program (NSQIP) database. Patients were categorized into two groups: patients with and without a postoperative COVID-19 diagnosis. Coarsened Exact Matching was used to match the groups based on preoperative risk factors, and outcomes were compared.Results: A total of 47,948 patients were included. In the aggregate cohort, 31% were male, and mean age was 50 years. Age, BMI, smoking, COPD, CHF, preoperative sepsis, and ASA class were significantly different between the two groups. After matching, there were no differences in characteristics. 30-day morbidity (OR = 2.7, 95% CI 1.4-5.1), pneumonia (OR = 5.0, 95% CI 1.7-15.0), DVT (OR = 8.22, 95% CI 1.0-66), reoperation (OR = 9.3, 95% CI 1.2-73.8), and readmission (OR = 4.8, 95% CI 2.3-10.1) continued to be significantly worse in the matched cohort.Conclusion: Postoperative COVID-19 infection was associated with worse outcomes after laparoscopic cholecystectomy. These findings suggest that even postoperative COVID-19 diagnosis increases the risk for adverse outcomes in patients recovering from laparoscopic cholecystectomy and may indicate that precautions should be taken and new COVID-19 infections even after surgery should be closely monitored.
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Affiliation(s)
- Alexandra Moulton
- Department of Surgery, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Jessica K Liu
- Department of Surgery, Harbor UCLA Medical Center, Torrance, CA, USA
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA
| | - Christian Miguel de Virgilio
- Department of Surgery, Harbor UCLA Medical Center, Torrance, CA, USA
- Department of General Surgery, Harbor UCLA Medical Center, Torrance, CA, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Junko Ozao-Choy
- Department of Surgery, Harbor UCLA Medical Center, Torrance, CA, USA
- Department of General Surgery, Harbor UCLA Medical Center, Torrance, CA, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ashkan Moazzez
- Department of Surgery, Harbor UCLA Medical Center, Torrance, CA, USA
- Department of General Surgery, Harbor UCLA Medical Center, Torrance, CA, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Grimsley EA, Torikashvili JV, Janjua HM, Pietrobon R, Zander T, Kendall MA, Kuo PC, Read MD. Expanded analysis for patients with acute cholecystitis indicates outcomes vary based on COVID-19 status and treatment modality. J Gastrointest Surg 2024; 28:1113-1121. [PMID: 38719138 PMCID: PMC11382366 DOI: 10.1016/j.gassur.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND The impact of different phases of COVID-19 infection on outcomes from acute calculous cholecystitis (ACC) is not well understood. Therefore, we examined outcomes of acute cholecystitis during the COVID-19 pandemic, comparing the effect of different treatment modalities and COVID-19 infection status. We hypothesized that patients with acute COVID-19 would have worse outcomes than COVID-negative patients, but there would be no difference between COVID-negative and COVID-recovered patients. METHODS We used 2020-2023 National COVID Cohort Collaborative data to identify adults with ACC. Treatment (antibiotics-only, cholecystostomy tube, or cholecystectomy) and COVID-19 status (negative, active, or recovered) were collected. Treatment failure of nonoperative managements was noted. Adjusted analysis using a series of generalized linear models controlled for confounders (age, sex, body mass index, Charlson comorbidity index, severity at presentation, and year) to better assess differences in outcomes among treatment groups, as well as between COVID-19 groups. RESULTS In total, 32,433 patients (skewed count) were included: 29,749 COVID-negative, 2112 COVID-active, and 572 (skewed count) COVID-recovered. COVID-active had higher rates of sepsis at presentation. COVID-negative more often underwent cholecystectomy. Unadjusted, COVID-active had higher 30-day mortality, 30-day complication, and longer length of stay than COVID-negative and COVID-recovered. Adjusted analysis revealed cholecystectomy carried lower odds of mortality for COVID-active and COVID-negative patients than antibiotics or cholecystostomy. COVID-recovered patients' mortality was unaffected by treatment modality. Treatment failure from antibiotics was more common for COVID-negative patients. CONCLUSION Acute cholecystitis outcomes are affected by phase of COVID-19 infection and treatment modality. Cholecystectomy does not lead to worse outcomes for COVID-active and COVID-recovered patients than nonoperative treatments; thus, these patients can be considered for cholecystectomy if their physiology is not prohibitive.
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Affiliation(s)
- Emily A Grimsley
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States.
| | - Johnathan V Torikashvili
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Haroon M Janjua
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States; Department of Health Services, Policy, and Practice, Brown University, School of Public Health, Providence, Rhode Island, United States
| | - Ricardo Pietrobon
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States; SporeData, Inc, Durham, North Carolina, United States
| | - Tyler Zander
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Melissa A Kendall
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Meagan D Read
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States; Department of Surgical Oncology, Moffitt Cancer Center, Tampa, Florida, United States
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Naito K, Suda K, Shinoda K, Hashiba T, Sano W, Chiku T, Ando K, Ohtsuka M. Preoperative difficulty factors in delayed laparoscopic cholecystectomy: Tokyo Guidelines 2018 surgical difficulty score analysis. Asian J Endosc Surg 2024; 17:e13309. [PMID: 38584140 DOI: 10.1111/ases.13309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Tokyo Guidelines 2018 (TG18) recommend early laparoscopic cholecystectomy (LC) for low-risk acute cholecystitis (AC); however, some patients undergo delayed LC (DLC) after conservative treatment. DLC, influenced by chronic inflammation, is a difficult procedure. Previous studies on LC difficulty lacked objective measures. Recently, TG18 introduced a novel 25 findings difficulty score, which objectively assesses intraoperative factors. The purpose of this study was to use the difficulty score proposed in TG18 to identify and investigate the predictors of preoperative high-difficulty cases of DLC for AC. METHODS We retrospectively reviewed 100 patients with DLC after conservative AC treatment. The surgical difficulty of DLC was evaluated using a difficulty score. Based on previous studies, the highest scores in each category were categorized as grades A-C. RESULTS The severity of AC was mild in 51 patients and moderate in 49. Surgical outcomes revealed a distribution of difficulty scores, with grade C indicating high difficulty, showing significant differences in operative time, blood loss, achieving a critical view of safety, bailout procedures, and postoperative hospital stay compared with grades A and B. Regarding the preoperative risk factors, multivariate analysis identified age >61 years (p = .008), body mass index >27.0 kg/m2 (p = .007), and gallbladder wall thickness >6.2 mm (p = .001) as independent risk factors for grade C in DLC. CONCLUSION The difficulty score proposed in TG18 provides an objective framework for evaluating surgical difficulty, allowing for more accurate risk assessments and improved preoperative planning in DLC for AC.
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Affiliation(s)
- Kei Naito
- Department of General Surgery, Kamitsuga General Hospital, Kanuma, Tochigi, Japan
| | - Kotaro Suda
- Department of General Surgery, Kamitsuga General Hospital, Kanuma, Tochigi, Japan
| | - Kimio Shinoda
- Department of General Surgery, Kamitsuga General Hospital, Kanuma, Tochigi, Japan
| | - Takahiro Hashiba
- Department of General Surgery, Kamitsuga General Hospital, Kanuma, Tochigi, Japan
| | - Wataru Sano
- Department of General Surgery, Kamitsuga General Hospital, Kanuma, Tochigi, Japan
| | - Tsuyoshi Chiku
- Department of General Surgery, Kamitsuga General Hospital, Kanuma, Tochigi, Japan
| | - Katsuhiko Ando
- Department of General Surgery, Kamitsuga General Hospital, Kanuma, Tochigi, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
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Velamazán R, López‐Guillén P, Martínez‐Domínguez SJ, Abad Baroja D, Oyón D, Arnau A, Ruiz‐Belmonte LM, Tejedor‐Tejada J, Zapater R, Martín‐Vicente N, Fernández‐Esparcia PJ, Julián Gomara AB, Sastre Lozano V, Manzanares García JJ, Chivato Martín‐Falquina I, Andrés Pascual L, Torres Monclus N, Zaragoza Velasco N, Rojo E, Lapeña‐Muñoz B, Flores V, Díaz Gómez A, Cañamares‐Orbís P, Vinzo Abizanda I, Marcos Carrasco N, Pardo Grau L, García‐Rayado G, Millastre Bocos J, Garcia Garcia de Paredes A, Vaamonde Lorenzo M, Izagirre Arostegi A, Lozada‐Hernández EE, Velarde‐Ruiz Velasco JA, de‐Madaria E. Symptomatic gallstone disease: Recurrence patterns and risk factors for relapse after first admission, the RELAPSTONE study. United European Gastroenterol J 2024; 12:286-298. [PMID: 38376888 PMCID: PMC11017764 DOI: 10.1002/ueg2.12544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/26/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Delayed cholecystectomy in patients with symptomatic gallstone disease is associated with recurrence. Limited data on the recurrence patterns and the factors that determine them are available. OBJECTIVE We aimed to determine the pattern of relapse in each symptomatic gallstone disease (acute pancreatitis, cholecystitis, cholangitis, symptomatic choledocholithiasis, and biliary colic) and determine the associated factors. METHODS RELAPSTONE was an international multicenter retrospective cohort study. Patients (n = 3016) from 18 tertiary centers who suffered a first episode of symptomatic gallstone disease from 2018 to 2020 and had not undergone cholecystectomy during admission were included. The main outcome was relapse-free survival. Kaplan-Meier curves were used in the bivariate analysis. Multivariable Cox regression models were used to identify prognostic factors associated with relapses. RESULTS Mean age was 76.6 [IQR: 59.7-84.1], and 51% were male. The median follow-up was 5.3 months [IQR 2.1-12.4]. Relapse-free survival was 0.79 (95% CI: 0.77-0.80) at 3 months, 0.71 (95% CI: 0.69-0.73) at 6 months, and 0.63 (95% CI: 0.61-0.65) at 12 months. In multivariable analysis, older age (HR = 0.57; 95% CI: 0.49-0.66), sphincterotomy (HR = 0.58, 95% CI: 0.49-0.68) and higher leukocyte count (HR = 0.79; 95% CI: 0.70-0.90) were independently associated with lower risk of relapse, whereas higher levels of alanine aminotransferase (HR = 1.22; 95% CI: 1.02-1.46) and multiple cholelithiasis (HR = 1.19, 95% CI: 1.05-1.34) were associated with higher relapse rates. CONCLUSION The relapse rate is high and different in each symptomatic gallstone disease. Our independent predictors could be useful for prioritizing patients on the waiting list for cholecystectomies.
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Affiliation(s)
- Raúl Velamazán
- Department of GastroenterologyHospital Clínico Universitario Lozano BlesaZaragozaSpain
- Department of GastroenterologyAlthaia Xarxa Assistencial Universitària de ManresaManresaSpain
- IIS (Instituto de Investigacion Sanitaria) AragónZaragozaSpain
| | - Pablo López‐Guillén
- Department of GastroenterologyHospital General Universitario Dr.BalmisAlicanteSpain
- ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante)AlicanteSpain
| | - Samuel J. Martínez‐Domínguez
- Department of GastroenterologyHospital Clínico Universitario Lozano BlesaZaragozaSpain
- IIS (Instituto de Investigacion Sanitaria) AragónZaragozaSpain
| | - Daniel Abad Baroja
- IIS (Instituto de Investigacion Sanitaria) AragónZaragozaSpain
- Department of GastroenterologyHospital Universitario Miguel ServetZaragozaSpain
| | - Daniel Oyón
- Department of GastroenterologyHospital de GaldakaoBizkaiaSpain
- Instituto de Investigación Sanitaria BiocrucesBizkaiaSpain
| | - Anna Arnau
- Research and Innovation UnitAlthaia Xarxa Assistencial Universitària de ManresaManresaSpain
- Central Catalonia Chronicity Research Group (C3RG)Centre for Health and Social Care Research (CESS), University of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
- Faculty of MedicineUniversity of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
| | - Lara M. Ruiz‐Belmonte
- Department of GastroenterologyHospital Universitario Son EspasesPalma de MallorcaSpain
| | | | - Raul Zapater
- Department of Gastroenterology and HepatologyHospital Universitario Ramón y CajalMadridSpain
| | | | | | | | | | | | | | | | - Nuria Torres Monclus
- Department of GastroenterologyHospital Universitario Arnau de VilanovaLleidaSpain
| | | | - Eukene Rojo
- Department of GastroenterologyHospital Universitario de La PrincesaMadridSpain
- IIS (Instituto de Investigación Sanitaria)‐PrincesaMadridSpain
| | - Berta Lapeña‐Muñoz
- Department of GastroenterologyHospital Universitario San PedroLogroñoSpain
| | - Virginia Flores
- Department of GastroenterologyHospital Universitario Gregorio MarañónMadridSpain
| | - Arantxa Díaz Gómez
- Department of GastroenterologyHospital Universitario Gregorio MarañónMadridSpain
| | - Pablo Cañamares‐Orbís
- IIS (Instituto de Investigacion Sanitaria) AragónZaragozaSpain
- GastroenterologyHepatology and Nutrition UnitHospital Universitario San JorgeHuescaSpain
| | - Isabel Vinzo Abizanda
- Specialist in Family and Community Medicine. Hospital Universitario San JorgeHuescaSpain
| | - Natalia Marcos Carrasco
- Department of Gastroenterology and HepatologyHospital Universitario Ramón y CajalMadridSpain
| | - Laura Pardo Grau
- Department of GastroenterologyHospital Universitario Josep TruetaGironaSpain
| | - Guillermo García‐Rayado
- Department of GastroenterologyHospital Clínico Universitario Lozano BlesaZaragozaSpain
- IIS (Instituto de Investigacion Sanitaria) AragónZaragozaSpain
| | - Judith Millastre Bocos
- Department of GastroenterologyHospital Clínico Universitario Lozano BlesaZaragozaSpain
- IIS (Instituto de Investigacion Sanitaria) AragónZaragozaSpain
| | - Ana Garcia Garcia de Paredes
- Department of Gastroenterology and HepatologyHospital Universitario Ramón y CajalMadridSpain
- Universidad de AlcaláMadridSpain
- IRYCIS (Instituto Ramón y Cajal de Investigación Sanitaria)MadridSpain
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd) Instituto de Salud Carlos IIIMadridSpain
| | | | | | | | | | - Enrique de‐Madaria
- Department of GastroenterologyHospital General Universitario Dr.BalmisAlicanteSpain
- ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante)AlicanteSpain
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Tóth I, Ábrahám S, Karamya Z, Benkő R, Matuz M, Nagy A, Váczi D, Négyessy A, Czakó B, Illés D, Tajti M, Ivány E, Lázár G, Czakó L. Multidisciplinary management of acute cholecystitis during the COVID-19 pandemic. Sci Rep 2023; 13:16257. [PMID: 37759081 PMCID: PMC10533883 DOI: 10.1038/s41598-023-43555-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
The coronavirus disease 2019 pandemic had a major impact on most medical services. Our aim was to assess the outcome of acute cholecystitis during the nationwide lockdown period. All patients admitted to our emergency department for AC were analysed. Patient characteristics, performance status, AC severity, treatment modality and outcome of AC were assessed during the lockdown period (Period II: 1 April 2020-30 November 2021) and compared to a historical control period (Period I: 1 May 2017-31 December 2018). AC admissions increased by 72.8% in Period II. Patients were younger (70 vs. 74 years, p = 0.017) and greater in number in the CCI 1 group (20.4% vs. 11.2%, p = 0.043) in Period II. The unplanned readmission rate (6.3 vs. 0%, p = 0.004) and the gallbladder perforation (GP) rate was higher (18.0 vs. 7.3%, p = 0.006) in Period II. Percutaneous transhepatic gallbladder drainage (PTGBD) was more frequent (24.1 vs. 12.8%, p = 0.012) in Period II. In addition to a drop in patient age and CCI, a significant rise in the prevalence of acute cholecystitis, GP and unplanned readmissions was observed during the nationwide lockdown due to the COVID-19 pandemic. PTGBD was more frequent during this period, whereas successful conservative treatment was less frequent.
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Affiliation(s)
- I Tóth
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - S Ábrahám
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Z Karamya
- Divison of Gastroenterology, Department of Medicine, University of Szeged, Kálvária Sgt. 57., Szeged, 6725, Hungary
| | - R Benkő
- Department of Clinical Pharmacology, University of Szeged, Szeged, Hungary
| | - M Matuz
- Department of Clinical Pharmacology, University of Szeged, Szeged, Hungary
| | - A Nagy
- Department of Radiology, University of Szeged, Szeged, Hungary
| | - D Váczi
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - A Négyessy
- Department of Surgery, University of Szeged, Szeged, Hungary
- Department of Urology, University of Szeged, Szeged, Hungary
| | - B Czakó
- Divison of Gastroenterology, Department of Medicine, University of Szeged, Kálvária Sgt. 57., Szeged, 6725, Hungary
| | - D Illés
- Divison of Gastroenterology, Department of Medicine, University of Szeged, Kálvária Sgt. 57., Szeged, 6725, Hungary
| | - M Tajti
- Divison of Gastroenterology, Department of Medicine, University of Szeged, Kálvária Sgt. 57., Szeged, 6725, Hungary
| | - E Ivány
- Divison of Gastroenterology, Department of Medicine, University of Szeged, Kálvária Sgt. 57., Szeged, 6725, Hungary
| | - G Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - László Czakó
- Divison of Gastroenterology, Department of Medicine, University of Szeged, Kálvária Sgt. 57., Szeged, 6725, Hungary.
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