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Outcome of acute perforated cholecystitis: a register study of over 5000 cases from a quality control database in Germany

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Abstract

Background

Acute perforated cholecystitis (APC) is probably the most severe complication of acute cholecystitis. However, data on the outcome of cholecystectomy for APC are limited to small series. This study investigated the outcomes of cholecystectomy for APC.

Methods

Data from a prospectively maintained quality control database in Germany were analyzed. Cases with APC were compared to cases without gallbladder perforation with regard to demographic characteristics, clinical findings and surgical outcomes.

Results

A total of 5704 patients with APC were compared to 39,661 patients without perforation. Risk factors for APC included: the male gender, advanced age (>65 years), ASA score >2, elevated white blood count (WBC), positive findings on abdominal ultrasound sonography and fever. The APC group differed significantly from the control group with regard to fever (29.8 vs. 12.2 %), elevated WBC (83.8 vs. 65.4 %) and positive findings from ultrasound sonography (84.9 vs. 78.9 %), p < 0001. Preoperative computed tomography (CT) was ordered significantly more often in the APC group compared to the control group (2.3 vs. 1.0 %, p = 0.001). Surgery lasted significantly longer in the APC group (92.3 ± 40.8 vs. 73.7 ± 34.1, p < 0.001). The rates of conversion (18.9 vs. 6.8 %), bile duct injury (1.4 vs. 0.5 %), re-intervention (6.9 vs. 2.9 %) and mortality (4.3 vs. 1.3 %) were significantly higher in the APC group (p < 0.001). Similarly, the length of stay (13.4 ± 11.4 vs. 9.0 ± 8.3, p < 0.001) was significantly longer in the APC group.

Conclusion

Acute perforated cholecystitis is a severe complication of acute cholecystitis. Surgical dissection could be challenging with high risks of bile duct injury and conversion. The rates of morbidity and mortality are higher compared to those of patients without perforation.

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Authors and Affiliations

  1. Department of Surgery II, HELIOS Universitätsklinikum Wuppertal, Witten – Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany

    Stefan Jansen, Johannes Doerner, Hubert Zirngibl & Peter C. Ambe

  2. Institute of Quality Control in Health Care, Medical Association Nordrhein Westphalia, Tersteegenstr. 9, 40474, Düsseldorf, Germany

    Susanne Macher-Heidrich

Authors
  1. Stefan Jansen
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  2. Johannes Doerner
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  3. Susanne Macher-Heidrich
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  4. Hubert Zirngibl
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  5. Peter C. Ambe
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Corresponding author

Correspondence to Peter C. Ambe.

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Conflict of interest

Stefan Jansen, Johannes Doerner, Susanne Macher-Heidrich, Hubert Zirngibl and Peter C. Ambe have no conflicts of interest.

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Jansen, S., Doerner, J., Macher-Heidrich, S. et al. Outcome of acute perforated cholecystitis: a register study of over 5000 cases from a quality control database in Germany. Surg Endosc 31, 1896–1900 (2017). https://doi.org/10.1007/s00464-016-5190-5

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  • DOI: https://doi.org/10.1007/s00464-016-5190-5

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