title: Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis.
abstract: OBJECTIVE
  Prompt treatments for acute calculous cholecystitis can reduce both mortality and morbidity. The aim of this retrospective study was to assess the impact of the Tokyo guidelines on management of patients with acute cholecystitis.
  
  
  METHODS
  The records of patients admitted due to acute calculous cholecystitis were collected between January 2007 and June 2008. Exclusion criteria included acalculous, hepatobiliary malignancy, younger than 18 years old and mortality unrelated to cholecystitis. These 235 patients were classified into three groups; grade I, grade II and grade III, according to the severity grading in the Tokyo guidelines for acute cholecystitis. They were further classified into two subgroups; those compatible with and incompatible with managements suggested in the Tokyo guidelines, for comparison.
  
  
  RESULTS
  Lower levels of platelets, lower blood pressure, higher levels of C-reactive protein, blood urine nitrogen, prothrombin time, bilirubin, alkaline phosphatase, and more incidences of positive microorganisms cultured in bile or blood, were found in patients as the severity of disease progressed. Shorter mean length of hospital stay was compatible with the Tokyo guidelines, but no significant differences in outcomes, including incidences of survival, post-surgery complications and mortality, were found between the two subgroups.
  
  
  CONCLUSIONS
  No significant benefit of the application of the Tokyo guidelines in the management of patients was found between the two subgroups except for reduced mean length of hospital stay. The application of the Tokyo guidelines for improving the outcomes of patients with acute cholecystitis needs further investigation and evaluation.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. ericest@vghtc.gov.tw
authors.forename: Shou-Wu
authors.initials: SW
authors.lastname: Lee
authors.forename: Sheng-Shun
authors.initials: SS
authors.lastname: Yang
authors.forename: Chi-Sen
authors.initials: CS
authors.lastname: Chang
authors.forename: Hong-Jeh
authors.initials: HJ
authors.lastname: Yeh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D002767:Cholecystostomy; D005260:Female; D042882:Gallstones / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D019983:Guideline Adherence; D006801:Humans; D007564:Japan; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents