Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study
- Authors: Fugazzola P.; Cobianchi L.; Di Martino M.; Tomasoni M.; Dal Mas F.; Abu-Zidan F.M.; Agnoletti V.; Ceresoli M.; Coccolini F.; Di Saverio S.; Dominioni T.; Farè C.N.; Frassini S.; Gambini G.; Leppäniemi A.; Maestri M.; Martín-Pérez E.; Moore E.E.; Musella V.; Peitzman A.B.; de la Hoz Rodríguez Á.; Sargenti B.; Sartelli M.; Viganò J.; Anderloni A.; Biffl W.; Catena F.; Ansaloni L.; Augustin G.; Moric T.; Awad S.; Alzahrani A.M.; Elbahnasawy M.; Massalou D.; De Simone B.; Demetrashvili Z.; Kimpizi A.D.; Schizas D.; Balalis D.; Tasis N.; Papadoliopoulou M.; Georgios P.; Lasithiotakis K.; Ioannidis O.; Bains L.; Magnoli M.; Cianci P.; Conversano N.I.; Pasculli A.; Andreuccetti J.; Arici E.; Pignata G.; Tiberio G.A.M.; Podda M.; Murru C.; Veroux M.; Distefano C.; Centonze D.; Favi F.; Bova R.; Convertini G.; Balla A.; Sasia D.; Giraudo G.; Gabriele A.; Tartaglia N.; Pavone G.; D’Acapito F.; Fabbri N.; Ferrara F.; Cimbanassi S.; Ferrario L.; Cioffi S.; Fumagalli C.; Degrate L.; Degiuli M.; Sofia S.; Licari L.; Improta M.; Patriti A.; Coletta D.; Conti L.; Malerba M.; Andrea M.; Calabrò M.; De Zolt B.; Bellio G.; Giordano A.; Luppi D.; Corbellini C.; Sampietro G.M.; Marafante C.; Rossi S.; Mingoli A.; Lapolla P.; Cicerchia P.M.; Siragusa L.; Grande M.; Arcudi C.; Antonelli A.
- Publication year: 2023
- Type: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/613413
Abstract
BackgroundLess invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models.MethodThe S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models-POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade-receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities.ResultsA 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a 'Chole-POSSUM' score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96-97% negative predictive value for major complications.ConclusionsThe Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action.Trial Registration: ClinicalTrial.gov NCT04995380.