title: Gallbladder perforation: morbidity, mortality and preoperative risk prediction.
abstract: BACKGROUND
  Gallbladder perforation (GBP) is a life threatening complication of acute cholecystitis occurring in approximately 2-11 % of patients. The aim of this study is to analyse all factors associated with morbidity and mortality and assess the accuracy of preoperative risk prediction scores.
  
  
  METHODS
  Medical records of 1,033 patients who underwent cholecystectomy for acute cholecystitis in our centre between 2002 and 2012 were reviewed. Preoperative, intraoperative and postoperative relevant data were analysed with univariate and multivariate statistical methods to identify all factors associated with postoperative complications and mortality. Accuracy of ASA, POSSUM and APACHE II scores was also compared using receiver-operating characteristics methodology.
  
  
  RESULTS
  137 (12.4 %) patients with gallbladder perforation were identified. Morbidity and mortality rates were 57.7 and 9.5 %, respectively. At multivariate analysis, preoperative albumin (P = 0.007, OR 0.175), open surgery (P = 0.011, OR 37.78) and preoperative sepsis (P = 0.002, OR 51.647) were associated with complications, and preoperative sepsis was the only factor independently associated with hospital mortality (P = 0.007, OR 9.127). Both POSSUM and APACHE II scores were superior to ASA score in risk prediction.
  
  
  CONCLUSIONS
  Preoperative severe sepsis is the most important factor associated with postoperative morbidity and mortality following GBP, and it can be helpful to identify those patients needing the highest level of care possible.
authors.affiliation: HPB Unit, Department of Surgery, Hospital Xeral, Calle Pizarro 22, 36203, Vigo, PV, Spain, f.ausania@googlemail.com.
authors.forename: F
authors.initials: F
authors.lastname: Ausania
authors.forename: S
authors.initials: S
authors.lastname: Guzman Suarez
authors.forename: H
authors.initials: H
authors.lastname: Alvarez Garcia
authors.forename: P
authors.initials: P
authors.lastname: Senra del Rio
authors.forename: E
authors.initials: E
authors.lastname: Casal Nuñez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013030:Spain / Q000453:epidemiology