Gangrenous cholecystitis: a contemporary review.
BACKGROUND
Despite the established superiority of laparoscopic cholecystectomy (LC) for acute cholecystitis, gangrenous cholecystitis (GC) is commonly treated with open cholecystectomy (OC). This study aimed to characterize outcomes of GC in the modern era and between LC or OC surgical approach.


METHODS
Patients with a diagnosis of GC were identified using the 2005-2011 National Surgical Quality Improvement Project Participant User File. Baseline patient and operative characteristics and 30-d outcomes were established for all patients. Patients were stratified by surgical approach (LC or OC), and groups were propensity matched with a nearest-neighbor matching algorithm. Primary outcomes were 30-d mortality and any 30-d complication. A nonparsimonious multiple logistic regression model was used in the matched subset to adjust for patient comorbidities, demographics, and laboratory values.


RESULTS
A total of 141,970 cholecystectomies were identified with 7017 having a diagnosis of GC. Overall 30-d mortality for the entire cohort was 0.8% (n = 239) and overall 30-d complication rate was 8.0% (n = 2485). For GC patients, the 30-d mortality was 1.2% (n = 84) and overall complication rate was 10.8% (n = 761). The multivariate logistic regression model demonstrated a significant decrease in overall (odds ratio = 0.46; P < 0.001) complication rates for LC patients but did not reveal a significant difference in 30-d mortality (odds ratio = 0.59; P = 0.12).


CONCLUSIONS
GC is associated with increased morbidity and mortality compared with that of acute cholecystitis. A LC approach is a safe option for patients with GC and is associated with decreased 30-d morbidity. Although LC should be used when possible for GC to minimize postoperative complications, OC should not be avoided if necessary to ensure patient safety.
Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: asvin.ganapathi@duke.edu.
Asvin M
AM
Ganapathi
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Paul J
PJ
Speicher
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Brian R
BR
Englum
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Alexander
A
Perez
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Douglas S
DS
Tyler
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Sabino
S
Zani
D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D041881:Cholecystitis, Acute / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D005734:Gangrene / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D057216:Propensity Score; D016896:Treatment Outcome; D014481:United States
Cholecystectomy; Gangrenous cholecystitis