Predicting length of stay and conversion to open cholecystectomy for acute cholecystitis using the 2013 Tokyo Guidelines in a US population.
BACKGROUND
The 2013 Tokyo Guidelines (TG13) for acute cholecystitis have not been studied extensively in US populations.


METHODS
A retrospective review of patients with acute cholecystitis within a single system from 2009 to 2013 was performed. The diagnosis and severity of acute cholecystitis were assigned by the TG13. The primary outcome measures were length of stay and conversion to open cholecystectomy.


RESULTS
Four hundred and forty-five patients with acute cholecystitis were studied. For all patients, length of stay (P < 0.001), disposition to home (P < 0.001), and morbidity (P = 0.003) were related to increasing TG13 grade. For surgical patients (n = 256), worsened outcomes with increasing TG13 grade were seen for conversion to open (P = 0.001), operative duration (P < 0.001), length of stay (P < 0.001), disposition to home (P < 0.001), and readmission (P = 0.037). On multivariate analysis, TG13 grade was an independent predictor of increasing length of stay (P = 0.009) and conversion to open surgery (grade 2: OR 7.63 (2.25-25.90), grade 3: OR 24.2 (5.0-116.37)).


CONCLUSIONS
Wide adoption of the TG13 in the US can better inform patients, hospital systems, and payers of the expected outcomes of acute cholecystitis.
General Surgery Residency Program, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA. wrightgp@upmc.edu.|Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA. wrightgp@upmc.edu.|Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Avenue, Suite 414, Pittsburgh, PA, 15232, USA. wrightgp@upmc.edu.
G
G
Paul Wright
Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
Kellen
K
Stilwell
Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
Jared
J
Johnson
General Surgery Residency Program, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA.|Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
Matthew T
MT
Hefty
General Surgery Residency Program, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA.|Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.|Division of Surgical Specialties, Spectrum Health Medical Group, Grand Rapids, MI, USA.
Mathew H
MH
Chung
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging* / Q000601:surgery*; D015331:Cohort Studies; D061887:Conversion to Open Surgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D014041:Tokyo; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014481:United States
Cholecystectomy; Cholecystectomy, laparoscopic; Cholecystitis; Cholecystitis, acute