Gangrenous acute calculous cholecystitis is not classical acute calculous cholecystitis: A propensity score weighted study of postoperative outcomes

Background

Gangrenous acute calculous cholecystitis (GACC) is acute calculous cholecystitis (ACC) with gallbladder wall necrosis. This study compared specific postoperative course between grade II non-gangrenous acute calculous cholecystitis (NGACC) and GACC.

Methods

All patients with grade II ACC according to the Tokyo guidelines who underwent cholecystectomy from 2007 to 2019 in the first 5 days after onset of symptoms were included in this single-center retrospective study with propensity score weighting. The primary endpoint was overall postoperative complications according to the CCI (comprehensive complication index) compared between patients with GACC and grade II NGACC. Secondary endpoints were intraoperative complications, major complications according to the Clavien-Dindo classification, surgical site infection, medical complications, cholecystectomy-specific complications, reintervention, mortality, length of hospital stay, and readmission.

Results

390 patients underwent cholecystectomy, including 174 GACC. After propensity score weighting, overall postoperative complications according to the CCI (p < 0.001), major complication rate (14.5% vs. 8%, OR = 1.95, CI95% [1.02;3.76], p = 0.04), cholecystectomy-specific complication rate (8.4% vs. 3.3%, OR = 2.67, CI95% [1.06;6.76], p = 0.03), and mean length of hospital stay (5 days vs. 4 days, p = 0.009) were higher in the GACC than in the NGACC group. By contrast, there was no significant difference in reintervention (OR = 1.39, CI95% [0.68;2.85], p = 0.37), mortality (OR = 2.47, CI95% [0.43;14.07], p = 0.31) or readmission (OR = 1.09, IC95% [0.37;3.15], p = 0.87).

Conclusion

GACC is a specific form of grade II ACC with higher morbidity that needs specific peri-operative management.