Use of antibiotics in acute calculous cholecystitis – do tokyo guidelines improve the practices?

Abstract Background Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. Methods Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. Results The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7–12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34–12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02–1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5–28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). Conclusions Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. Trial registration Retrospectively registered and recorded in Clinical Trials. NCT04744441

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Correlation between the Severity and Outcome of Acute Calculous Cholecystits According to Tokyo Guidelines

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v17i1.25313 ◽

2019 ◽

Vol 17 (1) ◽

pp. 34-37 ◽

Cited By ~ 1

Author(s):

Pradip Thapa ◽

Krishna Mohan Adhikari ◽

Anup Sharma

Keyword(s):

Laparoscopic Cholecystectomy ◽

Diagnostic Criteria ◽

Morbidity And Mortality ◽

Tokyo Guidelines ◽

Acute Calculous Cholecystitis ◽

Severity Grading ◽

Grade Ii ◽

Emergency Cholecystectomy ◽

Calculous Cholecystitis ◽

Grade Iii

Introduction: Acute Calculous Cholecystitis is a condition in which the gallbladder becomes inflamed due to cholelithiasis. Early diagnosis, severity grading and appropriate intervention reduce both morbidity and mortality. The aim of this prospective study is to correlate the severity with the outcome of acute calculous cholecystitis according to Tokyo Guidelines. Methods: This was a hospital based prospective study conducted in the Department of Surgery, Nepalgunj Medical College Teaching Hospital for a period of two years from April 2017 to March 2019. The patients were classified into three groups according to the severity grading in the Tokyo guidelines (TG18/ TG13). Clinical characteristics among these patients were analyzed for comparison. Results: Among all diagnostic criteria, right upper quarter (RUQ)h abdominal pain (94%) Murphy's sign (94%) and thickened gallbladder wall (80%) had the highest sensitivity rates (p<0.032), whereas elevated white cell count (32%) and RUQ abdominal mass (32%) had the lowest sensitivity rates (p<0.035). Higher sensitivity rates of diagnostic criteria were related to severe cholecystitis, except for Fever (46%) and elevated white blood cell (WBC) count (32%). All the 28 patients in grade I and selected patients 3 out of 6in grade II underwent early laparoscopic cholecystectomy (LC) without any conversion and increased morbidity and mortality. Out of16 patients in grade III there was 2 mortalities due to ARDS, 1 needed Ultrasonography (USG) guided cholecystostomy, 1 underwent emergency cholecystectomy. 16 patients, 3 in grade II and 13 in grade III underwent interval laparoscopic cholecystectomy safely. There were no major postoperative morbidities except for superficial surgical site infection (SSI) in 1 patient in grade III who underwent emergency cholecystectomy Higher grade of severity was associated with increased morbidity and mortality (p<0.03). Conclusion: A combination of diagnostic criteria with different path physiologic findings, as noted in the Tokyo guidelines, can help clinicians make the correct diagnosis for patients with acute cholecystitis and there was strong correlation between the severity and outcomes of acute cholecystitis.

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Mortality Risk Estimation in Acute Calculous Cholecystitis: Beyond the Tokyo Guidelines

10.21203/rs.3.rs-283383/v1 ◽

2021 ◽

Author(s):

Ana-María González-Castillo ◽

Juan Sancho-Insenser ◽

Maite De Miguel-Palacio ◽

Josep-Ricard Morera-Casaponsa ◽

Estela Membrilla-Fernández ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Propensity Score ◽

Mortality Risk ◽

Characteristic Curve ◽

Chronic Obstructive ◽

Tokyo Guidelines ◽

Acute Calculous Cholecystitis ◽

Calculous Cholecystitis ◽

Non Surgical Treatment

Abstract Background: Acute Calculous Cholecystitis (ACC) is the second most frequent surgical condition in Emergency Departments. The recommended treatment is the Early Laparoscopic Cholecystectomy, however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patients for surgical treatment. The objective of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification.Methods: retrospective unicentric cohort study of patients emergently admitted with and ACC during January 1, 2011 to December 31, 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confunding factors comparing surgical treatment and non-surgical treatment.Results: the overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66:95%CI: 1.7-12.8 P=0.001), dementia (OR 4.12;95%CI: 1.34-12.7 P=0.001), age > 80 years (OR 1.12:95% CI: 1.02-1.21 P=0.001) and the need of preoperative vasoactive amines (OR 9.9:95%CI: 3.5-28.3 P=0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P=0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%).Conclusions: mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME could allow us to create a new alternative guideline to TG for treating ACC.Trial Registration: retrospectively registered and recorded in Clinical Trials (NTC 0474441).

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The role of the Tokyo guidelines in the diagnosis of acute calculous cholecystitis

Journal of Hepato-Biliary-Pancreatic Sciences ◽

10.1007/s00534-010-0289-x ◽

2010 ◽

Vol 17 (6) ◽

pp. 879-884 ◽

Cited By ~ 16

Author(s):

Shou-Wu Lee ◽

Chi-Sen Chang ◽

Teng-Yu Lee ◽

Chun-Fang Tung ◽

Yen-Chun Peng

Keyword(s):

Tokyo Guidelines ◽

Acute Calculous Cholecystitis ◽

Calculous Cholecystitis

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The timing of laparoscopic cholecystectomy and nano-ligation clip for acute calculous cholecystitis under guidance of Tokyo guidelines 2018 (multi-center retrospective analysis)

Materials Express ◽

10.1166/mex.2021.2085 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1681-1690

Author(s):

Hongsheng Wu ◽

Keqiang Ma ◽

Lei Yu ◽

Weili Gu ◽

Yong Yan ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Statistical Difference ◽

Operation Time ◽

Postoperative Hospital Stay ◽

Optimum Time ◽

Tokyo Guidelines ◽

Acute Calculous Cholecystitis ◽

Group A ◽

Calculous Cholecystitis

Laparoscopic cholecystectomy (LC) has been recognized as the standard surgical method for cholecystectomy. A nano-absorbable ligation clip. The material used in the ligation clip is composed of basic materials (poly(p-dioxanone), poly trimethylene carbonate or polycaprolactone) and nano-short fibers (Polyglycolide acid or polylactide). The short nano-fibers maintain the crystalline form evenly dispersed in the base material. The diameter of short nano-fibers is 300–500 nm and the length is 20–50 µm. The nano-absorbable ligation clip has strong closing force and will not cause closure failure. However, there are still some controversies about the optimum time for LC treatment of acute calculous cholecystitis (ACC) patients, and the optimum time for performing LC based on evidence-based medicine has not been unanimously recognized. Here, we explore LC timing for ACC treatment under the guidance of the Tokyo Guidelines for Acute Cholecystitis 2018 (TG18). We retrospectively analyzed the data of 3,147 ACC cases undergoing LC in eight hospitals in China. According to the time from the onset of the patient’s symptoms to the operation, they were divided into the following three groups: Group A (onset to operation time of ≤3 days), Group B (onset to operation time of 4–7 days), and Group C (onset to operation time of >7 days). There was no obvious statistical difference in preoperative indicators, such as gender ratio, history of hypertension, diabetes, and abdominal operation; ASA Classification; and TG18 Classification between the three groups. Similarly, the results of preoperative laboratory indices (e.g., white blood cell, C-reactive protein, procalcitonin, platelet, serum creatinine, and international normalized ratio) showed no obvious statistical difference between the three groups. The comparison of gallbladder characteristics under B-ultrasound showed no significant statistical difference between the three groups. However, the conversion rate in Group C was significantly higher than that in Groups A and B, the incidence of complications (e.g., bile leakage, bile duct injury, and wound infection) was significantly higher in Group C than that in Groups A and B, and the postoperative hospital stay was significantly shorter in Group A than that in Groups B and C. A comprehensive analysis of patients’ medical records in multiple medical centers confirms that it is safe and feasible to perform early LC 7 days before the onset of ACC, which can significantly decrease postoperative complications and shorten the postoperative hospital stay for ACC patients. Performing early LC for ACC patients under the TG18 guidelines is safe and feasible. Additionally, since TG18 has obvious practicability and guidance for the clinical practice of hepatobiliary surgery, it is worthy of popularization and application in China.

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