Predictive factors for the type of surgery in acute cholecystitis.
BACKGROUND
Whereas early cholecystectomy is accepted as the optimal timing for surgery, the best treatment modality for acute cholecystitis (AC) is still under debate. In this series, we aimed to assess the current treatment of AC in a single institution. In addition, preoperative criteria were defined predicting the severity of inflammation.


METHODS
From January 1995 to June 1999, 236 patients undergoing cholecystectomy for AC were prospectively evaluated. Outcome measures were the treatment modality, the severity of inflammation, white blood cell (WBC) count, C-reactive protein (CRP), morbidity, and hospital stay.


RESULTS
There were 115 laparoscopic cholecystectomies (LC), 77 primary open cholecystectomies (OC), and 44 conversions (CON) to OC. Patients with LC were significantly younger, in better condition, with a shorter duration of symptoms and lower CRP levels and WBC counts compared with OC and CON (P <0.001). Postoperative complications, reinterventions, and mean hospital stay were significantly increased after OC and CON (P <0.001). Overall mortality was 2.5%. Advanced AC was predominantly found in OC and CON (P <0.001). Patients with advanced AC were significantly older, predominantly male, and had a prolonged duration of symptoms as well as increased CRP levels and WBC counts (P <0.001). The conversion rate increased from 10% for mild AC up to 48% for necrotizing AC.


CONCLUSIONS
Based on laboratory (CRP, WBC), demographic (age, sex), and individual (American Society of Anesthesiologists classification, duration of symptoms) findings, it is possible to reliably predict the severity of inflammation. Therefore, an individualized surgical approach can be used for each patient and type of AC.
Schäfer
M
M
Department of Visceral and Transplantation Surgery, Inselspital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland. markus.buechler@insel.ch
Krähenbühl
L
L
Büchler
M W
MW
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index
D002097:C-Reactive Protein