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Evaluating the advantages of treating acute cholecystitis by following the Tokyo Guidelines 2018 (TG18): a study emphasizing clinical outcomes and medical expenditures

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Abstract

Background

Acute cholecystitis (AC) is a common surgical emergency. The Tokyo Guidelines 2018 (TG18) provides a reliable algorithm for the treatment of AC patients to achieve optimal outcomes. However, the economic benefits have not been validated. We hypothesize that good outcomes and cost savings can both be achieved if patients are treated according to the TG18.

Method

This retrospective study included 275 patients who underwent cholecystectomy in a 15-month span. Patients were divided into three groups (group 1: mild AC; group 2: moderate AC with American Society of Anesthesiologists (ASA) physical status class ≤ 2 and Charlson Comorbidity Index (CCI) score ≤ 5; and group 3: moderate AC with ASA class ≥ 3, CCI score ≥ 6, or severe AC). Each group was further divided into two subgroups according to management (followed or deviated from the TG18). Patient demographics, clinical outcomes, and hospital costs were compared.

Results

For group 1 patients, 77 (81%) were treated according to the TG18 and had a significantly higher successful laparoscopic cholecystectomy (LC) rate (100%), lower hospital cost ($1896 vs $2388), and shorter hospital stay (2.9 vs 8 days) than those whose treatment deviated from the TG18. For group 2 patients, 50 (67%) were treated according to the TG18 and had a significantly lower hospital cost ($1926 vs $2856), shorter hospital stay (3.9 vs 9.9 days), and lower complication rate (0% vs 12.5%). For group 3 patients, 62 (58%) were treated according to the TG18 and had a significantly lower intensive care unit (ICU) admission rate (9.7% vs 25%), but a longer hospital stay (12.6 vs 7.8 days). However, their hospital costs were similar. Early LC in group 3 patients did not have economic benefits over gallbladder drainage and delayed LC.

Conclusion

The TG18 are the state-of-the-art guidelines for the treatment of AC, achieving both satisfactory outcomes and cost-effectiveness.

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References

  1. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, Kozaka K, Endo I, Deziel DJ, Miura F, Okamoto K, Hwang TL, Huang WS, Ker CG, Chen MF, Han HS, Yoon YS, Choi IS, Yoon DS, Noguchi Y, Shikata S, Ukai T, Higuchi R, Gabata T, Mori Y, Iwashita Y, Hibi T, Jagannath P, Jonas E, Liau KH, Dervenis C, Gouma DJ, Cherqui D, Belli G, Garden OJ, Gimenez ME, de Santibanes E, Suzuki K, Umezawa A, Supe AN, Pitt HA, Singh H, Chan ACW, Lau WY, Teoh AYB, Honda G, Sugioka A, Asai K, Gomi H, Itoi T, Kiriyama S, Yoshida M, Mayumi T, Matsumura N, Tokumura H, Kitano S, Hirata K, Inui K, Sumiyama Y, Yamamoto M (2018) Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 25:41–54

    Article  Google Scholar 

  2. Onoe S, Kaneoka Y, Maeda A, Takayama Y, Fukami Y (2016) Feasibility of laparoscopic cholecystectomy for acute cholecystitis beyond 72 h of symptom onset. Updates Surg 68:377–383

    Article  Google Scholar 

  3. Roulin D, Saadi A, Di Mare L, Demartines N, Halkic N (2016) Early versus delayed cholecystectomy for acute cholecystitis, are the 72 hours still the rule?: A randomized trial. Ann Surg 264:717–722

    Article  Google Scholar 

  4. Loozen CS, Blessing MM, van Ramshorst B, van Santvoort HC, Boerma D (2017) The optimal treatment of patients with mild and moderate acute cholecystitis: time for a revision of the Tokyo Guidelines. Surg Endosc 31(10):3858–3863

    Article  Google Scholar 

  5. Amirthalingam V, Low JK, Woon W, Shelat V (2016) Tokyo Guidelines 2013 may be too restrictive and patients with moderate and severe acute cholecystitis can be managed by early cholecystectomy too. Surg Endosc 31(7):2892–2900

    Article  Google Scholar 

  6. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, Iwashita Y, Hibi T, Pitt HA, Umezawa A, Asai K, Han HS, Hwang TL, Mori Y, Yoon YS, Huang WS, Belli G, Dervenis C, Yokoe M, Kiriyama S, Itoi T, Jagannath P, Garden OJ, Miura F, Nakamura M, Horiguchi A, Wakabayashi G, Cherqui D, de Santibanes E, Shikata S, Noguchi Y, Ukai T, Higuchi R, Wada K, Honda G, Supe AN, Yoshida M, Mayumi T, Gouma DJ, Deziel DJ, Liau KH, Chen MF, Shibao K, Liu KH, Su CH, Chan ACW, Yoon DS, Choi IS, Jonas E, Chen XP, Fan ST, Ker CG, Gimenez ME, Kitano S, Inomata M, Hirata K, Inui K, Sumiyama Y, Yamamoto M (2018) Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci 25:55–72

    Article  Google Scholar 

  7. Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidl H (1991) The European experience with laparoscopic cholecystectomy. Am J Surg 161:385–387

    Article  CAS  Google Scholar 

  8. Kum CK, Eypasch E, Lefering R, Paul A, Neugebauer E, Troidl H (1996) Laparoscopic cholecystectomy for acute cholecystitis: is it really safe? World J Surg 20:43–48; discussion 48–49

  9. (1992) Gallstones and laparoscopic cholecystectomy. NIH Consens Statement 10:1–28

  10. Halldestam I, Enell EL, Kullman E, Borch K (2004) Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg 91:734–738

    Article  CAS  Google Scholar 

  11. Jenkins PJ, Paterson HM, Parks RW, Garden OJ (2007) Open cholecystectomy in the laparoscopic era. Br J Surg 94:1382–1385

    Article  CAS  Google Scholar 

  12. Livingston EH, Rege RV (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188:205–211

    Article  Google Scholar 

  13. David GG, Al-Sarira AA, Willmott S, Deakin M, Corless DJ, Slavin JP (2008) Management of acute gallbladder disease in England. Br J Surg 95:472–476

    Article  CAS  Google Scholar 

  14. Glasgow RE, Cho M, Hutter MM, Mulvihill SJ (2000) The Spectrum and Cost of Complicated Gallstone Disease in California. Arch Surg 135:1021–1025

    Article  CAS  Google Scholar 

  15. Khan SU, Soh JY, Muhibullah N, Peleki A, Abdullah M, Waterland PW (2019) Emergency Laparoscopic Cholecystectomy: Is Dedicated Hot Gall Bladder List Cost Effective? J Ayub Med Coll Abbottabad 31:3–7

    PubMed  Google Scholar 

  16. Gallagher TK, Kelly ME, Hoti E (2019) Meta-analysis of the cost-effectiveness of early versus delayed cholecystectomy for acute cholecystitis. BJS Open 3:146–152

    Article  CAS  Google Scholar 

  17. Terho PM, Leppaniemi AK, Mentula PJ (2016) Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications. World J Emerg Surg 11:54

    Article  Google Scholar 

  18. Loozen CS, van Santvoort HC, van Duijvendijk P, Besselink MG, Gouma DJ, Nieuwenhuijzen GA, Kelder JC, Donkervoort SC, van Geloven AA, Kruyt PM, Roos D, Kortram K, Kornmann VN, Pronk A, van der Peet DL, Crolla RM, van Ramshorst B, Bollen TL, Boerma D (2018) Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial. BMJ 363:k3965

    Article  Google Scholar 

  19. Portinari M, Scagliarini M, Valpiani G, Bianconcini S, Andreotti D, Stano R, Carcoforo P, Occhionorelli S (2018) Do I need to operate on that in the middle of the night? Development of a nomogram for the diagnosis of severe acute cholecystitis. J Gastrointest Surg 22:1016–1025

    Article  Google Scholar 

  20. Fleming MM, DeWane MP, Luo J, Liu F, Zhang Y, Pei KY (2019) A propensity score matched comparison of readmissions and cost of laparoscopic cholecystectomy vs percutaneous cholecystostomy for acute cholecystitis. Am J Surg 217:83–89

    Article  Google Scholar 

  21. Minutolo V, Licciardello A, Arena M, Nicosia A, Di Stefano B, Calì G, Arena G (2014) Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of outcomes and costs between early and delayed cholecystectomy. Eur Rev Med Pharmacol Sci 18:40–46

    CAS  PubMed  Google Scholar 

  22. Gutt CN, Encke J, Köninger J, Harnoss JC, Weigand K, Kipfmüller K, Schunter O, Götze T, Golling MT, Menges M, Klar E, Feilhauer K, Zoller WG, Ridwelski K, Ackmann S, Baron A, Schön MR, Seitz HK, Daniel D, Stremmel W, Büchler MW (2013) Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg 258:385–393

    Article  Google Scholar 

  23. Ozkardeş AB, Tokaç M, Dumlu EG, Bozkurt B, Ciftçi AB, Yetişir F, Kılıç M (2014) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective, randomized study. Int Surg 99:56–61

    Article  Google Scholar 

  24. Inoue K, Ueno T, Nishina O, Douchi D, Shima K, Goto S, Takahashi M, Shibata C, Naito H (2017) Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis. BMC Gastroenterol 17:71

    Article  Google Scholar 

  25. Bouassida M, Zribi S, Krimi B, Laamiri G, Mroua B, Slama H, Mighri MM, M’saddak Azzouz M, Hamzaoui L, Touinsi H (2019) C-reactive protein is the best biomarker to predict advanced acute cholecystitis and conversion to open surgery. A prospective cohort study of 556 cases. J Gastrointest Surg 24(12):2766–2772

    Article  Google Scholar 

  26. Rice CP, Vaishnavi KB, Chao C, Jupiter D, Schaeffer AB, Jenson WR, Griffin LW, Mileski WJ (2019) Operative complications and economic outcomes of cholecystectomy for acute cholecystitis. World J Gastroenterol 25:6916–6927

    Article  Google Scholar 

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Acknowledgements

The authors appreciate Dr. Hao-Chien Hung and Dr. Jin-Chiao Lee for assisting with the statistical analysis.

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Authors and Affiliations

  1. Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan

    Yu-Ning Lin & Shang-Yu Wang

  2. Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, No. 5 Fuxing St., Guishan District, Taoyuan City, 33305, Taiwan

    Yu-Tung Wu, Chih-Yuan Fu, Chien-Hung Liao, Chi-Tung Cheng, Being-Chuan Lin, Yu-Pao Hsu, Shih-Ching Kang, Erh-Hao Liu, I-Ming Kuo, Chun-Hsiang Ou Yang, Shang-Ju Yang, Jen-Fu Huang, Chih-Po Hsu, Feng-Jen Hsieh, Chien-An Liao, Ling-Wei Kuo, Yu-San Tee & Chi-Hsun Hsieh

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Correspondence to Chi-Hsun Hsieh.

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Drs. Yu-Ning Lin, Yu-Tung Wu, Chih-Yuan Fu, Chien-Hung Liao, Chi-Tung Cheng, Shang-Yu Wang, Being-Chuan Lin, Yu-Pao Hsu, Shih-Ching Kang, Erh-Hao Liu, I-Ming Kuo, Chun-Hsiang Ou Yang, Shang-Ju Yang, Jen-Fu Huang, Chih-Po Hsu, Chi-Tung Cheng, Feng-Jen Hsieh, Chien-An Liao, Ling-Wei Kuo, Yu-San Tee, and Chi-Hsun Hsieh have no conflicts of interest or financial ties to disclose.

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Lin, YN., Wu, YT., Fu, CY. et al. Evaluating the advantages of treating acute cholecystitis by following the Tokyo Guidelines 2018 (TG18): a study emphasizing clinical outcomes and medical expenditures. Surg Endosc 35, 6623–6632 (2021). https://doi.org/10.1007/s00464-020-08162-7

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