Gallbladder perforation: morbidity, mortality and preoperative risk prediction
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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.
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.
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.
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.
KeywordsGallbladder perforation Acute cholecystitis Mortality
Drs. Fabio Ausania, Silvia Guzman, Helena Alvarez, Paula Senra and Enrique Casal have no conflicts of interest or financial ties to disclose.
- 3.Strohl EL, Diffenbaugh WG, Baker JH, Chemma MH (1962) Collective reviews: gangrene and perforation of the gallbladder. Int Abstr Surg 114:1–7Google Scholar
- 4.Doherty GM, Way LW (2003) Biliary Tract. In: Way LW, Doherty GM (eds) Current Surgical Diagnosis & Treatment, 11th edn. McGraw-Hill, New York, pp 595–624Google Scholar
- 5.Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (2009) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. 1992. Chest 136(5):e28PubMedGoogle Scholar
- 19.Tzeng CW, Katz MH, Fleming JB, Lee JE, Pisters PW, Holmes HM, Varadhachary GR, Wolff RA, Abbruzzese JL, Vauthey JN, Aloia TA (2014) Morbidity and mortality after pancreaticoduodenectomy in patients with borderline resectable type C clinical classification. J Gastrointest Surg 18(1):146–156CrossRefPubMedGoogle Scholar
- 20.Cho SW, Tzeng CW, Johnston WC, Cassera MA, Newell PH, Hammill CW, Wolf RF, Aloia TA, Hansen PD (2014) Neoadjuvant radiation therapy and its impact on complications after pancreaticoduodenectomy for pancreatic cancer: analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). HPB (Oxford) 16(4):350–356CrossRefGoogle Scholar