Emergency Medicine: Open Access
Open Access

Abstract

Should We must Push for Primary Surgery Attempt in Case of Acute Cholecystitis? A Retrospective Analysis and a Proposal of an Evidence based Clinical Pathway

Michele Pisano, Marco Ceresoli, Luca Campanati, Federico Coccolini, Chiara Falcone, Michela Giulii Capponi, Fabrizio Palamara, Dario Piazzalunga, Elia Poiasina, Alessandra Tebaldi, Alberto Zucchi and Luca Ansaloni

The treatment and the correct management of acute calcolous cholecystitis (ACC), despite the presence of several studies, meta-analysis and guidelines are still debated and up to 80% of patients with ACC do not receive the definitive surgical treatment during the first hospital admission. A retrospective analysis of patients admitted with non-complicated acute cholecystitis in our hospital has been performed and on the basis of this analysis we proposed evidence based clinical pathway. 502 patients were selected, with a mean age of 62.09 years old, 56% of male sex and a mean Charlson comorbidity index of 2.96. 32.1% of the patients were not operated during all the observed period. Cholecystectomy during the first hospitalization was performed in 44.2% of the cases with a conversion rate of 15.34%, a cumulative hospital stay of 8.08 days and a mean cost of 3904 €. Delayed cholecystectomy after a mean of 119 days was chosen in 23.7% of the patients, 84.80% as elective procedure and 15.2% in urgency. Conversion rate was 13.7%. Cumulative hospital stay was 13.02 days and cumulative costs were 4660 €. Early cholecystectomy resulted better in term of cumulative hospital stay and costs (p<0.0001) without difference in term of conversion rate and complications, according to data in the literature. On the base of these considerations we propose an evidence based clinical pathway for the treatment of ACC.