title: Risk factors for acute gangrenous cholecystitis in emergency general surgery patients.
abstract: BACKGROUND
  Acute gangrenous cholecystitis (AGC) is a medical emergency that carries high morbidity. The objective of this study is to define risk factors for this disease.
  
  
  METHODS
  A retrospective review of patients who underwent cholecystectomy while admitted to the Acute Care Surgery Service from January 2009 to April 2014 was performed. Specimen reports were evaluated to identify patients with AGC and cholecystitis without necrosis (CN). Preoperative factors as well as outcomes were compared between the groups.
  
  
  RESULTS
  A total of 483 patents underwent cholecystectomy. Four hundred fifty-nine patients were found to have CN and 24 patients were found to have AGC. Pre-existent factors such as diabetes, coronary artery disease, and systemic inflammatory response syndrome predicted AGC on a logistic regression. Patients with AGS were also more commonly older, male, and had a higher preoperative bilirubin. Mortality was significantly higher in patients with AGC (12.5% vs .9%, P = .003).
  
  
  CONCLUSIONS
  AGC carries an increased mortality rate compared with CN. Older patients with diabetes, coronary artery disease, and elevated bilirubin should be suspected of having AGC.
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, 16th Floor, West Hospital, 1200 E. Broad Street, Richmond, VA 23219, USA.
authors.forename: Seda
authors.initials: S
authors.lastname: Bourikian
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, 16th Floor, West Hospital, 1200 E. Broad Street, Richmond, VA 23219, USA.
authors.forename: Rahul J
authors.initials: RJ
authors.lastname: Anand
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, 16th Floor, West Hospital, 1200 E. Broad Street, Richmond, VA 23219, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Aboutanos
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, 16th Floor, West Hospital, 1200 E. Broad Street, Richmond, VA 23219, USA.
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, 16th Floor, West Hospital, 1200 E. Broad Street, Richmond, VA 23219, USA. Electronic address: pferrada@mcvh-vcu.edu.
authors.forename: Paula
authors.initials: P
authors.lastname: Ferrada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D004630:Emergencies; D005260:Female; D005734:Gangrene; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute cholecystitis; Complicated cholecystitis; Gangrenous cholecystitis