Colecistitis aguda alitiásicaestudio controlado según el procedimiento terapéutico

Abstract

Abstract Introduction: acute cholecystitis is one of the most common surgical emergencies and it consists in the inflammation of the gallbladder, mainly caused by stones. There is a small percentage of cases in which there are not gallstones, so, those are acalculous acute cholecystitis forms. This type of cholecystitis is less studied and there are not high evidence articles comparing surgical treatment and conservative treatment, so this is the reason of this study. Methods: an observational study of a series of 227 cases of acute acalculous cholecystitis is carried out. The sample size is calculated according to the complication rate from previous studies, calculated, adding a precision of a 5%. The sample is obtained form 5 public hospitals of the Región de Murcia, between 2010 and 2016. After collecting 92 variables, a statistical analysis is performed using the program IBM-SPSS v25. Initially, a univariant analysis in which the different variables between treatment groups are compared is carried out. In addition, a matching analysis is done, using the variables age, gender and medical history. After that, an analysis using logistic regression of significant variables and of those variables identified as independent is performed. All are two-tailed tests and it is considerer significant when p is equal or less than 0,05. Results: acute acalculous cholecystitis is rare and the number of cases is stable over the years. The mean age of the cases was 75 years, but the patients in the surgical group were 10 years younger (65.9 vs 75.1 years, p <0.001), with a lower Charlson index (p <0.001) and mainly ASA II (versus ASA III in non-operated patients, p <0.001). Furthermore, women underwent to surgery less than men (p = 0.003). The mean of days before medical care was 3.2 days and did not shows differences between groups. The main consultation symptom was abdominal pain and there were no significant differences in vital signs taken at admission, imaging tests performed, or analytical results during the stay or at discharge. Operated patients were admitted more frequently in General Surgery and those not operated in Internal Medicine (p <0.001). The overall complication rate was 30.3%, with no differences in the comparative analysis (p = 0.219), but two risk factors for complications were found: age (OR 1.028, 95% CI 1.003-1.053; p = 0.026) and the presence of an ASA III or IV index (OR 2.813, 95% CI 1.493-5.300; p = 0.001). Non-operated patients had more frequently positive blood and bile cultures (p = 0.062 and p = 0.030) and operated patients were admitted to intensive care more easily (p = 0.005), with no differences in the SOFA and SAPS II scores or in stay, but there were differences in the use of mechanical ventilation (p = 0.006) and vasoactive medications (p = 0.022). Hospital stay was 11.3 days in the group of operated patients and 12.2 days in the non-operated group (p = 0.391) and the days with antibiotic therapy was 11.6 versus 14.1 (p = 0.058). Mortality was 5.3% and readmissions after 30 days, 7.5%, with no differences between treatment groups (p = 0.183 and p = 0.261). Conclusions: no significant differences were found between groups of treatment, neither in mortality, nor in readmissions in 30 days, nor in stay, although mortality was higher in not operated patients in this study. Operated patients are more frequently admitted to ICU, and are more commonly men, younger and with fewer comorbidities than not operated patients. There are not differences in terms of complications between groups, but risk factors to develop complications are older age and increased surgical risk. Keywords: Cholecystitis, Acalculous Cholecystitis, Cholecystectomy, Cholecistostomy, Conservative Treatment.