title: Predicting gangrenous cholecystitis.
abstract: BACKGROUND
  Gangrenous cholecystitis (GC) is often challenging to treat. The objectives of this study were to determine the accuracy of pre-operative diagnosis, to assess the rate of post-cholecystectomy complications and to assess models to predict GC.
  
  
  METHODS
  A retrospective single-institution review identified patients undergoing a cholecystectomy. Logistic regression models were used to examine the association of variables with GC and to build risk-assessment models.
  
  
  RESULTS
  Of 5812 patients undergoing a cholecystectomy, 2219 had acute, 4837 chronic and 351 GC. Surgeons diagnosed GC pre-operatively in only 9% of cases. Patients with GC had more complications, including bile-duct injury, increased estimated blood loss (EBL) and more frequent open cholecystectomies. In unadjusted analyses, variables significantly associated with GC included: age >45 years, male gender, heart rate (HR) >90, white blood cell count (WBC) >13,000/mm(3), gallbladder wall thickening (GBWT) ≥ 4 mm, pericholecystic fluid (PCCF) and American Society of Anesthesiology (ASA) >2. In adjusted analyses, age, WBC, GBWT and HR, but not gender, PCCF or ASA remained statistically significant. A 5-point scoring system was created: 0 points gave a 2% probability of GC and 5 points a 63% probability.
  
  
  CONCLUSIONS
  Using models can improve a diagnosis of GC pre-operatively. A prediction of GC pre-operatively may allow surgeons to be better prepared for a difficult operation.
authors.affiliation: The Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Buddensick
authors.forename: Hamid
authors.initials: H
authors.lastname: Ferdosi
authors.forename: Dusty Marie
authors.initials: DM
authors.lastname: Narducci
authors.forename: Amanda
authors.initials: A
authors.lastname: Sautter
authors.forename: Lisa
authors.initials: L
authors.lastname: Setiawan
authors.forename: Haroon
authors.initials: H
authors.lastname: Shaukat
authors.forename: Mustafa
authors.initials: M
authors.lastname: Siddique
authors.forename: Gisela N
authors.initials: GN
authors.lastname: Sulkowski
authors.forename: Farin
authors.initials: F
authors.lastname: Kamangar
authors.forename: Gopal C
authors.initials: GC
authors.lastname: Kowdley
authors.forename: Steven C
authors.initials: SC
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D015142:Baltimore; D002763:Cholecystectomy / Q000009:adverse effects; D002764:Cholecystitis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D002908:Chronic Disease; D003661:Decision Support Techniques; D005260:Female; D005704:Gallbladder / Q000473:pathology* / Q000601:surgery; D005734:Gangrene; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome