RESUMEN
BACKGROUND: Although index cholecystectomy is considered the treatment of choice for acute cholecystitis (AC), many hospital systems struggle to provide such a service. The aim of this study was to analyze the effect of failure to perform index cholecystectomy in patients presenting with acute cholecystitis. METHODS: Between June 2010 and December 2015, all patients presenting to one hospital with an initial attack of AC were enrolled into a prospective database. Patient's records were reviewed up until point of delayed cholecystectomy or for a minimum of 24 months after the initial presentation with AC. Recurrent AC was defined as early (<6 weeks from initial discharge) or late (>6 weeks from initial discharge). RESULTS: In total 998 patients presented with AC, 409 (41%) of whom were discharged without index cholecystectomy. Eighty-three (20%) patients presented with AC recurrence (ACR). Compared to the first AC episode, patients were more likely to present with grade III AC and suffer significantly greater morbidity (p < 0.05 for all comparisons). A prior history of biliary disease was associated with ACR (p = 0.002). ACR occurred early in 48 (58%) patients and delayed in 35 (42%) patients. CONCLUSIONS: Twenty percent of patients discharged without cholecystectomy after their first attack of ACR will develop recurrence within the first two years. Half of ACR will occur within 6 weeks. Patients who present with ACR are more likely to develop more severe AC and are likely to suffer greater morbidity as compared to their first attack.
Asunto(s)
Colecistectomía/efectos adversos , Colecistitis Aguda/cirugía , Complicaciones Posoperatorias/etiología , Tiempo de Tratamiento , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Colecistitis Aguda/diagnóstico , Bases de Datos Factuales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Recurrencia , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenAsunto(s)
Abdomen Agudo , Hemoperitoneo , Vólvulo Gástrico , Abdomen Agudo/diagnóstico por imagen , Abdomen Agudo/etiología , Abdomen Agudo/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo , Femenino , Tracto Gastrointestinal/diagnóstico por imagen , Tracto Gastrointestinal/cirugía , Hemoperitoneo/diagnóstico por imagen , Hemoperitoneo/etiología , Hemoperitoneo/cirugía , Humanos , Laparotomía , Persona de Mediana Edad , Vólvulo Gástrico/complicaciones , Vólvulo Gástrico/diagnóstico por imagen , Vólvulo Gástrico/cirugía , Tomografía Computarizada por Rayos XRESUMEN
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