Rebecca C Gologorsky, MD1, Justin Tse, MD2, Dylan Wolman, MD2, Aya Kamaya, MD2. 1University of California San Francisco-East Bay, 2Stanford University
Introduction: Gangrenous cholecystitis (GC) is a highly morbid complication of acute cholecystitis (AC). Risk factors for gangrenous progression are poorly described, as are pre-operative clinical features and post-operative outcomes in the era of minimally invasive surgery.
Methods and Procedures: Patients who underwent cholecystectomy for AC from January 2014-May 2018 at a single academic medical center were retrospectively reviewed, with pathologic confirmation of GC vs. uncomplicated acute cholecystitis (UAC) in all included patients.
Pertinent clinical features, demographics, and laboratory values were recorded. Two-tailed t-tests and Fisher’s exact tests were used to determine statistical significance for continuous and categorical variables, respectively.
Results: Among the 101 patients reviewed, 48 (48%) had GC and 53 (52%) had UAC. Patients with GC were older (62±17 vs. 48±18; p=0.0001) and predominantly male (65% vs 38%; p=0.005). Delays in diagnosis or treatment were significantly more common among patients with GC (46% vs 17%, p=0.0025), defined as a failure to recognize or treat acute cholecystitis at initial emergency department or urgent care visit up to 14 days prior to surgical admission (Table 1). Among patients with delayed care, none were surgically evaluated until subsequent admission. Mean time from imaging to surgical consult did not differ between groups (4.3h vs. 4.6h, p=0.9167). Following surgical consultation, there was no difference in mean time to surgery (24.6h vs. 21.0h, p=0.4128). Among patients with GC, 17 (35%) underwent open cholecystectomy, of which 13 (27%) were converted from a laparoscopic approach. Among patients with UAC, only 2 (3.7%; p=0.0001) underwent open cholecystectomy, both converted from a laparoscopic approach. Postoperatively, 5 (10%) patients with GC were admitted to the ICU versus 1 (2%) UAC patient (p=0.0994), and total length of hospitalization was greater among GC patients (5.0d vs. 2.7d; p=0.0022). Complication rates were higher among GC patients (17% vs. 3.8%; p=0.0441), with greater complication severity, including one death (2%).
Conclusion: GC is a clinically under-recognized surgical urgency. Delays in diagnosis of AC and subsequent surgical consultation contribute to its prevalence. A need for improved diagnostic recognition of AC is necessary to reduce risk of progression to GC, and to rapidly treat GC on presentation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93057
Program Number: P202
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster