Single center retrospective analysis of early vs. delayed treatment in acute calcolous cholecystitis: application of a clinical pathway and an economic analysis

Pisano, Michele; Ceresoli, Marco; Allegri, A; Belotti, Eugenia; Catena, Fausto; Colombi, Renata; Manfredi, Roberto; Margarito, Francesco; Merli, Cecilia; Montori, Giulia; Piazzalunga, Dario; Ansaloni, Luca

doi:10.5505/tjtes.2015.62679

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…In the two cohort research papers, no differences in bile duct injury and mortality rates were observed before and after the introduction of treatment strategies in line with severity grading, but overall hospital stays were shorter and medical costs lower following the introduction of this method. In some of the case series studies, survival rates and complication rates differed for each severity grading, so the authors were in agreement with the TG13 treatment strategies that are based on severity . In other case series studies, surgical outcomes were equivalent across the cholecystitis severity gradings for patients assessed as capable of withstanding surgery and who underwent early surgery; so, other authors considered TG13 to be too restrictive .…”

Section: Introductionmentioning

confidence: 77%

“…We performed a literature search for the period after creating the TG13 guidelines (January 2013–December 2016) using the key words acute cholecystitis, severity, laparoscopic cholecystectomy, cholecystectomy, and biliary drainage. We identified two cohort research papers and eight case series studies . In the two cohort research papers, no differences in bile duct injury and mortality rates were observed before and after the introduction of treatment strategies in line with severity grading, but overall hospital stays were shorter and medical costs lower following the introduction of this method.…”

Section: Introductionmentioning

confidence: 99%

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Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

Okamoto

Suzuki

Takada

et al. 2017

J Hepato Biliary Pancreat

598

471

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We propose a new flowchart for the treatment of acute cholecystitis (AC) in the Tokyo Guidelines 2018 (TG18). Grade III AC was not indicated for straightforward laparoscopic cholecystectomy (Lap-C). Following analysis of subsequent clinical investigations and drawing on Big Data in particular, TG18 proposes that some Grade III AC can be treated by Lap-C when performed at advanced centers with specialized surgeons experienced in this procedure and for patients that satisfy certain strict criteria. For Grade I, TG18 recommends early Lap-C if the patients meet the criteria of Charlson comorbidity index (CCI) ≤5 and American Society of Anesthesiologists physical status classification (ASA-PS) ≤2. For Grade II AC, if patients meet the criteria of CCI ≤5 and ASA-PS ≤2, TG18 recommends early Lap-C performed by experienced surgeons; and if not, after medical treatment and/or gallbladder drainage, Lap-C would be indicated. TG18 proposes that Lap-C is indicated in Grade III patients with strict criteria. These are that the patients have favorable organ system failure, and negative predictive factors, who meet the criteria of CCI ≤3 and ASA-PS ≤2 and who are being treated at an advanced center (where experienced surgeons practice). If the patient is not considered suitable for early surgery, TG18 recommends early/urgent biliary drainage followed by delayed Lap-C once the patient's overall condition has improved. Free full articles and mobile app of TG18 are available at:

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Section: Introductionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

Okamoto

Suzuki

Takada

et al. 2017

J Hepato Biliary Pancreat

598

471

View full text Add to dashboard Cite

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“…It is also associated with prolonged lengths of ICU and hospital stay and increased costs . Primary abdominal closure is recommended by day 7 or 8 following DCL to minimize complications that were shown to occur at an increased incidence after this time point . Postoperative continuous neuromuscular blocking agent (NMBA) use was associated with more than 3 times the odds of achieving primary fascial closure by day 7 when administered within 24 hours of DCL .…”

mentioning

confidence: 99%

“…2,5,9 Primary abdominal closure is recommended by day 7 or 8 following DCL to minimize complications that were shown to occur at an increased incidence after this time point. 5,[10][11][12] Postoperative continuous neuromuscular blocking agent (NMBA) use was associated with more than 3 times the odds of achieving primary fascial closure by day 7 when administered within 24 hours of DCL. 13 As a result of these outcomes, some clinicians use continuous NMBA in the routine management of trauma patients with an open abdomen.…”

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confidence: 99%

Effect of Neuromuscular Blocking Agents on Sedation Requirements in Trauma Patients with an Open Abdomen

2019

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The appropriate level of sedation in patients with an open abdomen following damage control laparotomy (DCL) is debated. Chemical paralysis with neuromuscular blocking agents (NMBAs) has been used to decrease time to abdominal closure. We sought to evaluate the effect of NMBA use on sedation requirements in patients with an open abdomen and to determine the effect of sedation on patient outcomes. A retrospective cohort study was conducted at an American College of Surgeons’ verified level 1 trauma center. Adult trauma patients who underwent DCL between 2009 and 2015 were included. Patients with an intensive care unit length of stay of less than 48 hours and those who died before abdominal closure were excluded. The NMBA+ group received continuous NMBA within 24 hours of DCL; the NMBA− group did not. The primary outcome was cumulative sedation dose during the 7 days following DCL. Secondary outcomes included Richmond Agitation‐Sedation Scale (RASS) score, mechanical ventilation‐free days, and delirium‐coma‐free days. Delirium‐coma‐free days were analyzed with linear regression. A total of 222 patients were included (NMBA+ 125; NMBA− 97). Demographics were similar between groups including age, Injury Severity Score, and mechanism of injury. The median time to closure in the overall cohort was 2 days (interquartile range [IQR] 1–2 days). Propofol and fentanyl were the primary sedatives used. The NMBA+ group received higher cumulative doses of propofol (NMBA+ 5405 mg, IQR 3103–10,573 mg; NMBA− 3601 mg, IQR 1605–6887 mg; p=0.007), but not of fentanyl. Time to abdominal closure, but not NMBA use, was associated with a higher cumulative propofol dose on multivariate analysis. The NMBA+ group had significantly lower RASS scores on the first 3 days following DCL. Mechanical ventilation‐free days (NMBA+ 20 days vs NMBA− 18 days, p=0.960) and delirium‐coma‐free days (NMBA+ 18 days vs NMBA− 18 days, p=0.610) were similar between the groups. On linear regression, cumulative propofol dose was associated with fewer delirium‐coma‐free days (β‐coefficient −0.007, 95% confidence interval −0.015 to −0.003). In trauma patients managed with DCL, higher cumulative sedative doses were administered in patients who received adjunctive NMBA, although NMBA therapy was not associated with a higher cumulative propofol dose on multivariate analysis. Consideration must be given to the potential effect of sedation on delirium and awakening following DCL.

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“…Minutolo et al included 92 patients, the duration of total hospitalization in the early group was 4 days shorter than the delayed group of patients (3). In a 2015 study, which included 502 patients, divided into 209 early and 233 delayed surgeries, Pisano et al reported results for shorter hospitalization in the early group by 2.5 days and no differences in postoperative complications (10). Like the coworkers, in a June 2018 study, they analyzed 86 patients divided into early and delayed groups of patients through hospitalization days (4 vs 7 days), cost (9,349 vs 12,361 Canadian dollars), and equal postoperative morbidity in both groups (11).…”

Section: Discussionmentioning

confidence: 99%

Early vs. Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis - Single Center Experience

et al. 2020

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Introduction: Laparoscopic cholecystectomy is now considered the procedure of choice that achieves a shorter recovery period after the surgery and reduction in the cost of treatment. Aim: The aim of the study is to prove which method: early or delayed laparoscopic cholecystectomy is the method of choice in the treatment of acute cholecystitis by examining: duration of hospitalization, conversion rate, duration of surgery, postoperative complications, and total cost. Methods: The study was conducted at the University Clinical Center of Republika Srpska as a retrospective-prospective study from May 1 st 2013 until December 31 st 2019. Patients diagnosed with acute cholecystitis were divided into two groups: Patients designated for early laparoscopic cholecystectomy within 72 hours of admission (group A-42 patients), Patients designated for initial conservative treatment followed by a delayed interval of 6-12 weeks until surgery (group B-42 patients). Results: In both groups, there were statistically significantly more female respondents. The results showed that the average cost of treatment in the early treated group was statistically significantly lower than the cost of treatment in the delayed treatment group. The patients in the early group had shorter hospitalization times (an average of 2.8 days and 5.6 days in the delayed group of patients), a smaller percentage of conversions (4.8% in the early and 16.7 in the delayed group of patients), the total cost of in the early group it was 1300.83 KM, while in the delayed group it was 1645.43 KM. Conclusion: Early laparoscopic cholecystectomy is a method to be preferred in surgical treatment.

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Single center retrospective analysis of early vs. delayed treatment in acute calcolous cholecystitis: application of a clinical pathway and an economic analysis

Cited by 8 publications

References 28 publications

Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

Effect of Neuromuscular Blocking Agents on Sedation Requirements in Trauma Patients with an Open Abdomen

Early vs. Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis - Single Center Experience

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