Fahad Ali, BA, Amir Aryaie, MD, Eneko Larumbe, PhD, Mark Williams, MD, Edwin Onkendi, MD. Texas Tech University Health Sciences Center
Introduction: Acute cholecystitis (AC) is diagnosed by characteristic gallbladder ultrasonographic findings (high specificity, low sensitivity). Hepatobiliary scintigraphy (HIDA) may be needed to confirm AC (higher sensitivity and specificity). The aim of this study was to assess the impact of the current selective use of HIDA scan for sonographically equivocal cases of AC on outcomes
Methods: A retrospective chart review of patients treated for AC at our institution (1/2015 to 12/2016) was performed. Patients were divided into 2 groups: the Ultrasound Only group (US-only) and the Ultrasound-HIDA group (US-HIDA). Timing of US and HIDA, and intervention for AC since presentation to emergency room (ER), and their impact on outcomes were analyzed. AC severity was graded per the TG3-Tokyo guidelines.
Results: A total of 110 patients were analyzed. The 2 groups were statistically similar with regards to age, body mass index, ASA class II, III and IV, extent of leukocytosis at presentation and liver functions test levels at presentation. In the US-only group, diagnostic ultrasound was obtained sooner, [median of 3 (interquartile range, IQR 1.3-8.7) hours] from presentation to the ER compared to the US-HIDA group, [10.9 (IQR 3.6-40.6) hours], p=0.007. HIDA was obtained after a median delay of 11.5 (IQR 3.7-25) hours from a non-diagnostic ultrasound. Majority of patients (87%) in the US-only group had mild (TG3 grade I) to moderate (TG3 grade II) AC, while 78% of the US-HIDA group had moderate (TG3 grade II) to severe (TG3 grade III) AC (p=0.003). Despite this, more patients in the US-HIDA group (39%) had a “normal” non-diagnostic ultrasound compared to the US-only group (4.3%), p<0.001. Seven patients in the US-HIDA group had no intervention due to normal HIDA scan (2), AC misdiagnosis due to liver cirrhosis (1), and severe medical comorbidities (4). More patients (74%) in the US-only group underwent laparoscopic cholecystectomy, compared to 39% in the US-HIDA group (p=0.006). Between the two groups, there was no significant differences in 90-day morbidity, mortality and reoperations. However, the length of stay was longer by a median of 3.5 days in the US-HIDA group (p=0.003).
Conclusion: Patients with moderate to severe AC are more likely to need HIDA scan due to a “normal” non-diagnostic ultrasound, have a delay in diagnosis, not have intervention for AC due to severe medical comorbidities and have lower chance of laparoscopic cholecystectomy. The length of hospital stay is significantly longer for these patient by a median of 3.5 days.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87091
Program Number: P094
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster