A predictive grading scale for acute cholecystitis

BackgroundAcute cholecystitis presents in a spectrum of severity, where acute disease may be complicated by severe inflammation, gangrene, and perforation. The goal of this study is to outline an evidence-based grading scale that predicts patient outcomes after laparoscopic cholecystectomy (LC).MethodsA retrospective review of all patients with a preoperative diagnosis of acute cholecystitis who underwent LC from August 2011 until June 2015 at a tertiary-level hospital was performed. Patients who underwent elective cholecystectomy, incidental cholecystectomy, a planned open cholecystectomy, had gallstone pancreatitis or choledocholithiasis, and those admitted to a non-surgical service were excluded. Severity of disease was obtained from operative and pathology reports, and patients were classified according to the following grading scale:Grade I: symptomatic cholelithiasis.Grade II: acute/chronic cholecystitis.Grade III: gangrenous/necrotizing cholecystitis.Grade IV: gallbladder perforation or abscess.The groups were compared on age, gender, body mass index, severity of gallbladder disease, presence of preoperative systemic inflammatory response syndrome, hospital length of stay, length of operation, complications within 30 days, conversion to open rate, and cost of hospitalization.ResultsDuring the study period, 1252 patients who underwent laparoscopic cholecystectomy were analyzed; 677 met inclusion criteria. The most common grade was grade 2, which was present in 80% of patients, followed by grade 3, which was found in 16% of patients. Grade 4 cholecystitis occurred in 1.2% of patients and grade 1 occurred in 3.2% of patients. There were statistically significant increases in age, presence of preoperative systemic inflammatory response syndrome, hospital length of stay, conversion to open rate, cost of hospitalization, and length of operation with increased cholecystitis grade.ConclusionsThe proposed grading scale is an accurate predictor of duration of operation, conversion to open rate, hospital length of stay, and cost of hospitalization.Level of evidenceIIIStudy typePrognostic

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Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy

Diabetes Care ◽

10.2337/dc19-0963 ◽

2020 ◽

Vol 44 (1) ◽

pp. 107-115

Author(s):

Hsiu-Yin Chiang ◽

Kuan-Ting Robin Lin ◽

Ya-Luan Hsiao ◽

Han-Chun Huang ◽

Shih-Ni Chang ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Blood Glucose ◽

Length Of Stay ◽

Blood Glucose Level ◽

Glucose Level ◽

Hospital Length ◽

Hospital Length Of Stay

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Systemic Inflammatory Response Syndrome Score and Race As Predictors of Length of Stay in the Intensive Care Unit

American Journal of Critical Care ◽

10.4037/ajcc2009267 ◽

2009 ◽

Vol 18 (4) ◽

pp. 339-346 ◽

Cited By ~ 11

Author(s):

E. G. NeSmith ◽

S. P. Weinrich ◽

J. O. Andrews ◽

R. S. Medeiros ◽

M. L. Hawkins ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Systemic Inflammatory Response

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Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy

10.2337/figshare.13110221 ◽

2020 ◽

Author(s):

Kuan-Ting Robin Lin ◽

Hsiu-Yin Chiang ◽

Ya-Luan Hsiao ◽

Han-Chun Huang ◽

Shih-Ni Chang ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Blood Glucose ◽

Length Of Stay ◽

Missing Values ◽

Medical Center ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Adjusted Relative Risk ◽

Adjusted Risk ◽

Laparoscopic Cholecystectomy Group

OBJECTIVE To evaluate the effect of preoperative blood glucose (POBG) level on hospital length of stay (LOS) in patients undergoing appendectomy or laparoscopic cholecystectomy. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of patients aged ≥18 years who had undergone either appendectomy or laparoscopic cholecystectomy procedures between 2005 and 2016 at a tertiary medical center in Taiwan. The association between POBG level and LOS was evaluated using a multivariable quasi-Poisson regression with robust variance. Multiple imputations were performed to replace missing values. RESULTS We included a total of 8,291 patients; 4,025 patients underwent appendectomy (appendectomy group) and 4,266 underwent laparoscopic cholecystectomy (laparoscopic cholecystectomy group). In the appendectomy group, patients with POBG levels of ≥123 mg/dL (adjusted relative risk [aRR], 1.19; 95% CI, 1.06–1.33) had a 19% higher risk of having a LOS of >3 days than did those with POBG levels of <106 mg/dL. In the laparoscopic cholecystectomy group, patients with POBG levels of ≥128 mg/dL also had a significantly higher risk of having a LOS of >3 days (aRR, 1.17; 95% CI, 1.07–1.29) than did those with POBG levels of <102 mg/dL. A positive dose–response curve between POBG and an adjusted risk of a LOS of >3 days was observed, despite the curve starts to flatten at a POBG level of approximately 130 mg/dL. CONCLUSIONS We demonstrated that a higher POBG level was significantly associated with a prolonged LOS for patients undergoing appendectomy and laparoscopic cholecystectomy. The optimal POBG level may be lower than that commonly perceived.

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Patterns and Effects of Admission Hyperglycemia And Inflammatory Response in Trauma Patients: A Prospective Study

10.21203/rs.3.rs-106402/v1 ◽

2020 ◽

Author(s):

Ayman El-Menyar ◽

Mohammad Asim ◽

Fayaz Mir ◽

Suhail Hakim ◽

Ahad Kanbar ◽

...

Keyword(s):

Blood Glucose ◽

Length Of Stay ◽

Inflammatory Response ◽

Injury Severity ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Severity Of Injury ◽

Hs Crp ◽

Initial Blood

Abstract Background: Hyperglycemia following trauma could be a response to stress. The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and inflammatory response in a level 1 trauma center admissions. Methods: A prospective, observational study was conducted for adult trauma patients who were admitted and tested for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6 ,Il-18 and hs-CRP. Patients were categorized into 4 groups (non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stress-induced hyperglycemic (SIH)). The inflammatory markers were measured on 3 time points (admission, 24 h, and 48 h). Pearson’s correlation test and logistic regression analysis were performed. We hypothesized that higher initial readings of blood glucose and cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients.Results: During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with hyperglycemia (SIH&DH); of whom 50% had SIH. Compared to the other 3 groups; SIH patients were younger, had significantly higher ISS, higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had lower Revised Trauma Score (p=0.005), lower Trauma Injury Severity Score (p=0.01) and lower GCS (p=0.001). IL-18 and hs-CRP were comparable among the study groups. Compared to the normoglycemia groups, patients with hyperglycemia had elevated high- sensitive troponin T (p=0.001) and required more blood transfusion (p=0.03). Patients with hyperglycemia had 3-times higher in-hospital mortality than the normoglycemia groups (p=0.02). A significant correlation was identified between initial blood glucose and serum lactate, IL-6, ISS and hospital length of stay. IL-6 correlated well with ISS (r=0.40, p=0.001). On- admission blood glucose had age-sex-GCS adjusted odd ratio 1.20(95% CI 1.06-1.33, p=0.003) for severe injury (ISS≥16).Conclusions: On-admission hyperglycemia is associated with a significant severer injury than normoglycemia patients. Initial blood glucose correlates with serum IL-6 which indicates a potential role of the systemic inflammatory response in the disease pathogenesis among the injured patients. On-admission glucose level could be a useful marker of injury severity, triage and risk assessment in trauma patients.This study was registered at the ClinicalTrials.gov (Identifier: NCT02999386), retrospectively Registered on December 21, 2016 https://clinicaltrials.gov/ct2/show/NCT02999386.

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Modelling the hospital length of stay for patients undergoing laparoscopic cholecystectomy through a multiple regression model

10.1145/3472813.3472826 ◽

2021 ◽

Author(s):

Arianna Scala ◽

Teresa Angela Trunfio ◽

Anna Borrelli ◽

Giuseppe Ferrucci ◽

Maria Triassi ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Length Of Stay ◽

Regression Model ◽

Multiple Regression ◽

Multiple Regression Model ◽

Hospital Length ◽

Hospital Length Of Stay

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Preoperative Dexamethasone Enhances Quality of Recovery after Laparoscopic Cholecystectomy

Anesthesiology ◽

10.1097/aln.0b013e3181ec642e ◽

2011 ◽

Vol 114 (4) ◽

pp. 882-890 ◽

Cited By ~ 98

Author(s):

Glenn S. Murphy ◽

Joseph W. Szokol ◽

Steven B. Greenberg ◽

Michael J. Avram ◽

Jeffery S. Vender ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Postanesthesia Care Unit ◽

Control Group ◽

Quality Of Recovery ◽

Pain Scores ◽

Dexamethasone Group

Background The effect of dexamethasone on quality of recovery after discharge from the hospital after laparoscopic surgery has not been examined rigorously in previous investigations. We hypothesized that preoperative dexamethasone would enhance patient-perceived quality of recovery on postoperative day 1 in subjects undergoing laparoscopic cholecystectomy. Methods One hundred twenty patients undergoing outpatient laparoscopic cholecystectomy were randomized to receive either dexamethasone (8 mg) or placebo-saline. A 40-item quality-of-recovery scoring system (QoR-40) was administered preoperatively and on postoperative day 1 to all subjects. Nausea, vomiting, fatigue, and pain scores were recorded at the time of discharge from the postanesthesia care unit and ambulatory surgical unit. Hospital length of stay was also assessed. Results Global QoR-40 scores on postoperative day 1 were higher in the dexamethasone group (median [range], 178 [130-195]) compared with the control group (161 [113-194]) (median difference [99% CI], -18 [-26 to -8]; P < 0.0001). Postoperative QoR-40 scores in the dimensions of emotional state, physical comfort, and pain were all improved in the dexamethasone group compared with the control group (P < 0.001). Nausea, fatigue, and pain scores were all reduced in the dexamethasone group during the hospitalization, as were postoperative analgesic requirements (P < 0.05). Total hospital length of stay was also reduced in subjects administered steroids (P = 0.003). Conclusions Among patients undergoing outpatient laparoscopic cholecystectomy surgery, the use of preoperative dexamethasone enhanced postdischarge quality of recovery and reduced nausea, pain, and fatigue in the early postoperative period.

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Relationship of Systemic Inflammatory Response Syndrome to Organ Dysfunction, Length of Stay, and Mortality in Critical Surgical Illness

Archives of Surgery ◽

10.1001/archsurg.134.1.81 ◽

1999 ◽

Vol 134 (1) ◽

pp. 81 ◽

Cited By ~ 119

Author(s):

Mia Talmor

Keyword(s):

Length Of Stay ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Organ Dysfunction ◽

Systemic Inflammatory Response ◽

Relationship Of

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Patterns and Effects of Admission Hyperglycemia and Inflammatory Response in Trauma Patients: A Prospective Clinical Study

World Journal of Surgery ◽

10.1007/s00268-021-06190-5 ◽

2021 ◽

Author(s):

Ayman El-Menyar ◽

Mohammad Asim ◽

Fayaz Mir ◽

Suhail Hakim ◽

Ahad Kanbar ◽

...

Keyword(s):

Blood Glucose ◽

Length Of Stay ◽

Inflammatory Response ◽

Injury Severity Score ◽

Inflammatory Markers ◽

Injury Severity ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Severe Injuries

Abstract Background The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and inflammatory response in a level 1 trauma center. We hypothesized that higher initial readings of blood glucose and cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients. Methods A prospective, observational study was conducted for adult trauma patients who were admitted and tested for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6, IL-18 and hs-CRP. Patients were categorized into four groups [non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stress-induced hyperglycemic (SIH)]. The inflammatory markers were measured on three time points (admission, 24 h and 48 h). Generalized estimating equations (GEE) were used to account for the correlation for the inflammatory markers. Pearson’s correlation test and logistic regression analysis were also performed. Results During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with hyperglycemia (50% had SIH and 50% had DH). Patients with SIH were younger, had significantly higher Injury Severity Score (ISS), higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had lower Revised Trauma Score (p = 0.005), lower Trauma Injury Severity Score (p = 0.01) and lower GCS (p = 0.001). Patients with hyperglycemia had higher in-hospital mortality than the normoglycemia group (12.5% vs 3.7%; p = 0.02). A significant correlation was identified between the initial blood glucose level and serum lactate, IL-6, ISS and hospital length of stay. Overall rate of change in slope 88.54 (95% CI:-143.39–33.68) points was found more in hyperglycemia than normoglycemia group (p = 0.002) for IL-6 values, whereas there was no statistical significant change in slopes of age, gender and their interaction. The initial IL-6 levels correlated with ISS (r = 0.40, p = 0.001). On-admission hyperglycemia had an adjusted odds ratio 2.42 (95% CI: 1.076–5.447, p = 0.03) for severe injury (ISS > 12) after adjusting for age, shock index and blood transfusion. Conclusions In trauma patients, on-admission hyperglycemia correlates well with the initial serum IL-6 level and is associated with more severe injuries. Therefore, it could be a simple marker of injury severity and useful tool for patient triage and risk assessment. Trial registration This study was registered at the ClinicalTrials.gov (Identifier: NCT02999386), retrospectively Registered on December 21, 2016. https://clinicaltrials.gov/ct2/show/NCT02999386.

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