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Surgical Endoscopy

, Volume 29, Issue 4, pp 955–960 | Cite as

Gallbladder perforation: morbidity, mortality and preoperative risk prediction

  • F. AusaniaEmail author
  • S. Guzman Suarez
  • H. Alvarez Garcia
  • P. Senra del Rio
  • E. Casal Nuñez
Article

Abstract

Introduction

Gallbladder perforation (GBP) is a life threatening complication of acute cholecystitis occurring in approximately 2–11 % of patients. The aim of this study is to analyse all factors associated with morbidity and mortality and assess the accuracy of preoperative risk prediction scores.

Methods

Medical records of 1,033 patients who underwent cholecystectomy for acute cholecystitis in our centre between 2002 and 2012 were reviewed. Preoperative, intraoperative and postoperative relevant data were analysed with univariate and multivariate statistical methods to identify all factors associated with postoperative complications and mortality. Accuracy of ASA, POSSUM and APACHE II scores was also compared using receiver-operating characteristics methodology.

Results

137 (12.4 %) patients with gallbladder perforation were identified. Morbidity and mortality rates were 57.7 and 9.5 %, respectively. At multivariate analysis, preoperative albumin (P = 0.007, OR 0.175), open surgery (P = 0.011, OR 37.78) and preoperative sepsis (P = 0.002, OR 51.647) were associated with complications, and preoperative sepsis was the only factor independently associated with hospital mortality (P = 0.007, OR 9.127). Both POSSUM and APACHE II scores were superior to ASA score in risk prediction.

Conclusion

Preoperative severe sepsis is the most important factor associated with postoperative morbidity and mortality following GBP, and it can be helpful to identify those patients needing the highest level of care possible.

Keywords

Gallbladder perforation Acute cholecystitis Mortality 

Notes

Disclosures

Drs. Fabio Ausania, Silvia Guzman, Helena Alvarez, Paula Senra and Enrique Casal have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • F. Ausania
    • 1
    Email author
  • S. Guzman Suarez
    • 1
  • H. Alvarez Garcia
    • 1
  • P. Senra del Rio
    • 1
  • E. Casal Nuñez
    • 1
  1. 1.HPB Unit, Department of SurgeryHospital XeralVigoSpain

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