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Di Martino MCorresponding AuthorRubio-Perez IAuthorAsensio Gómez, LuisAuthor or co-author of article in journal with external admissions assessment committee

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How to Predict Postoperative Complications After Early Laparoscopic Cholecystectomy for Acute Cholecystitis: the Chole-Risk Score

Publicated to:JOURNAL OF GASTROINTESTINAL SURGERY. 25 (11): 2814-2822 - 2021-11-01 25(11), DOI: 10.1007/s11605-021-04956-9

Authors: Di Martino, Marcello; Mora-Guzman, Ismael; Jodra, Victor Vaello; Dehesa, Alfonso Sanjuanbenito; Garcia, Dieter Morales; Ruiz, Ruben Caina; Nisa, Francisca Garcia-Moreno; Moreno, Fernando Mendoza; Batanero, Sara Alonso; Sampedro, Jose Edecio Quinones; Cumplido, Paola Lora; Bravo, Altea Arango; Rubio-Perez, Ines; Asensio-Gomez, Luis; Aranda, Fernando Pardo; Farrarons, Sara Senti; Moreno, Cristina Ruiz; Moreno, Clara Maria Martinez; Lasarte, Aingeru Sarriugarte; Calvo, Mikel Prieto; Aparicio-Sanchez, Daniel; Del Pozo, Eduardo Perea; Pellino, Gianluca; Martin-Perez, Elena

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Abstract

Background: Early laparoscopic cholecystectomy (ELC) is the gold standard treatment for patients with acute calculous cholecystitis (ACC); however, it is still related to significant postoperative complications. The aim of this study is to identify factors associated with an increased risk of postoperative complications and develop a preoperative score able to predict them. Methods: Multicentric retrospective analysis of 1868 patients with ACC submitted to ELC. Included patients were divided into two groups according to the presentation of increased postoperative complications defined as postoperative complications ≥ Clavien-Dindo IIIa, length of stay greater than 10 days and readmissions within 30 days of discharge. Variables that were independently predictive of increased postoperative complications were combined determining the Chole-Risk Score, which was validated through a correlation analysis. Results: We included 282 (15.1%) patients with postoperative complications. The multivariate analysis predictors of increased morbidity were previous percutaneous cholecystostomy (OR 2.95, p=0.001), previous abdominal surgery (OR 1.57, p=0.031) and diabetes (OR 1.62, p=0.005); Charlson Comorbidity Index >6 (OR 2.48, p=0.003), increased total bilirubin > 2 mg/dL (OR 1.88, p=0.002), dilated bile duct (OR 1.79, p=0.027), perforated gallbladder (OR 2.62, p<0.001) and severity grade (OR 1.93, p=0.001). The Chole-Risk Score was generated by grouping these variables into four categories, with scores ranging from 0 to 4. It presented a progressive increase in postoperative complications ranging from 5.8% of patients scoring 0 to 47.8% of patients scoring 4 (p<0.001). Conclusion: The Chole-Risk Score represents an intuitive tool capable of predicting postoperative complications in patients with ACC.

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