Organ system dysfunction following open cholecystectomy for acute acalculous cholecystitis in critically ill patients.
BACKGROUND
Acute acalculous cholecystitis (AAC) refers to cholecystitis without gallstones and is a serious complication of critical illness. We describe the time course of organ system dysfunction associated with cholecystectomy in critically ill patients with AAC.


METHODS
The data of all intensive care unit (ICU) patients who had operatively confirmed AAC during their ICU stay between 2003 and 2004 were analyzed. Patients who also had other intra-abdominal pathologies were excluded. The Sequential Organ Failure Assessment (SOFA) scores were recorded 3 days before, on the day of operation and on the first, second, third and seventh post-operative day after cholecystectomy. The impact of open cholecystectomy on organ dysfunction was evaluated on the basis of the change in the total and individual organ SOFA scores.


RESULTS
Twenty-four patients underwent open cholecystectomy for AAC with no other intra-abdominal pathology. Sepsis was the most common admission diagnosis, followed by cardiovascular surgery. The mean (standard deviation, SD) Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS) II and SOFA scores on admission were 24.7 (5.8), 44.3 (12.3) and 9.4 (3.2), respectively. The median (25th, 75th percentiles) total SOFA score 3 days before cholecystectomy was 7.5 (1.3, 8.0), which increased to 10.5 (8.3, 13.0) (P < 0.0001) by the day of cholecystectomy, indicating developing multiorgan dysfunction. After the operation, the score decreased to 5.5 (3.3, 10.8) (P = 0.004) by the seventh post-operative day. The change was most obvious in cardiovascular and respiratory SOFA scores.


CONCLUSIONS
AAC is associated with multiorgan dysfunction in critically ill patients. Open cholecystectomy seems to alter the course of multiorgan dysfunction in these patients.
Laurila
J
J
Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland. jouko.laurila@pp.fimnet.fi
Laurila
P A
PA
Saarnio
J
J
Koivukangas
V
V
Syrjälä
H
H
Ala-Kokko
T I
TI
D018806:APACHE; D042101:Acalculous Cholecystitis / Q000150:complications* / Q000601:surgery*; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods*; D015331:Cohort Studies; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors