Introduction
Patients and methods
Ethical considerations
Study protocol
Patients
Study variables
Statistical analysis
Results
Epidemiological and clinical features | Non-COVID 2412 | COVID N = 180 | p |
---|---|---|---|
Age | 61.97 (17.3) | 63.93(15.8) | 0.21 |
Gender | 012 | ||
Male | 1268 (52.7%) | 84 (46.7%) | |
Female | 1140 (47.3%) | 96 (53.3%) | |
Setting of acquisition | 0.01 | ||
Community based | 2027 (89.5%) | 143(82.7%) | |
Hospital based | 239 (10.5%) | 30 (17.3%) | |
Immunodeficiency | 101 (4.2%) | 12 (6.7%) | 0.13 |
Malignancy | 167 (7%) | 13 (7.3%) | 0.88 |
Severe cardiovascular disease | 490 (20.4%) | 58 (32.2%) | p < 0.0001 |
Diabetes | p < 0.0001 | ||
No diabetes | 1856 (77%) | 126 (70%) | |
Prediabetes | 37 (1.5%) | 11 (6.1%) | |
History of diabetes | 123 (5.1%) | 16 (8.9%) | |
Diabetes without complications | 321 (13.3%) | 19 10.6%) | |
Diabetes with complication | 74 (3.1%) | 8 (4.4%) | |
Severe CKD | 91 (3.8%) | 8 (4.5%) | 0.55 |
Severe COPD | 155 (6.4%) | 22 (12.4%) | 0.005 |
ARDS | 24 (1%) | 27 (15.2%) | p < 0.0001 |
PIPAS score | 0 (0–7) | 1 (0–6) | p < 0.0001 |
WSES score | 1 (0–15) | 2 (0–16) | p < 0.0001 |
qSOFA score | 0 (0–5) | 0 (0–8) | p < 0.0001 |
Tokyo classification of severity of AC | 1.62 (0.66) | 1.87 (0.75) | p < 0.0001 |
Patients having complications | 282 (11.7%) | 57 (32.2%) | p < 0.0001 |
Clavien-Dindo complication score | 1 (1–4) | 2 (1–4) | p < 0.0001 |
Hospital stay (days) | 6.51 (5.6) | 13.21 (12.6) | p < 0.0001 |
Mortality | 40 (1.7%) | 24 (13.4%) | p < 0.0001 |
Clinical findings | Non-COVID group n = 2412 | COVID group n = 180 | p |
---|---|---|---|
Duration of symptoms (days) | 3.66 (7.52) | 3.71 (6.85) | 0.88 |
Abdominal findings | 0.006 | ||
No pain | 53 (2.2%) | 2 (1.1%) | |
Localized pain | 1510 (62.8%) | 93 (52%) | |
Localized pain and rigidity | 541 (22.5%) | 48 (26.8%) | |
Diffuse abdominal pain | 299 (12.4%) | 36 (20.1%) | |
Peritonitis | 0.002 | ||
Localized | 1520 (95.1%) | 127 (88.2%) | |
Generalized | 78 (4.9%) | 17 (11.8%) | |
Core temperature (°C) | 36.87 (0.81) | 37.32 (0.92) | p < 0.0001 |
Heart rate (bpm) | 84.3 (16.6) | 89.7 (14.8) | p < 0.0001 |
Systolic blood pressure (mmHg) | 131.5 (23.4) | 124 (23.4) | p < 0.0001 |
Respiratory rate (breaths/min) | 17.1 (3.25) | 19.3 (3.73) | p < 0.0001 |
SpO2 (%) | 97 (97–100) | 94 (80–100) | p < 0.0001 |
Shock | 85 (3.5%) | 20 (11.2%) | p < 0.0001 |
Preoperative diagnosis | p = 0.18 | ||
Gallstone cholecystitis | 2177 (90.8%) | 161 (92%) | |
Acalculous cholecystitis | 93 (3.9%) | 8 (4.6%) | |
Biliary pancreatitis | 19 (0.8%) | 2 (1.1%) | |
Gallbladder mucocele | 18 (0.8%) | 0 (0%) | |
CBD stones | 85 (3.5%) | 3 (1.7%) | |
Cholangitis | 4 (0.2%) | 0 (0%) | |
Others | 1 (0.04%) | 1 (0.6%) |
Laboratory tests results | Non-COVID group n = 2412 | COVID group n = 180 | p value |
---|---|---|---|
WBC (count/mm3) | 7 501 (18 690) | 8156 (8266) | 0.04 |
Platelets (mm3) | 119 882 (141 627) | 118 550 (130 685) | 0.38 |
C reactive protein (mg/L) | 80.15 (102.5) | 89.44 (98.35) | 0.002 |
AST U/L value | 90.9 (174) | 87.7 (108.4) | < 0.0001 |
ALT U/L value | 95.5 (150.3) | 94.6 (128.1) | 0.001 |
Total bilirubin (mg/dL) | 5.38 (26.24) | 9.07 (19.99) | < 0.0001 |
Conjugated bilirubin (mg/dL) | 2.31 (8.14) | 5.83 (15.89) | < 0.0001 |
Indirect bilirubin (mg/dL) | 2.43 (15.78) | 3.66 (6.39) | 0.001 |
GGT U/L value | 141.92 (201.64) | 131.5 (156.3) | 0.21 |
Procalcitonin (µg/L) | 4.05 (16.52) | 4.32(12.8) | 0.29 |
Lactate (mmol/L) | 16.96 (79) | 3.52 (12.73) | 0.03 |
Fibrinogen (g/L) | 307.34 (569.49) | 254.1 (322.2) | 0.29 |
D-dimer (nmol/L) | 456.8 (1644) | 858.5 (2382) | 0.02 |
Prothrombin time (s) | 18.1 (20.54) | 17.46 (16.29) | 0.5 |
APTT (s) | 26.39 (11.54) | 31.52 (8.94) | < 0.0001 |
INR | 1.4 (4.13) | 1.24 (0.71) | 0.017 |
Management | Count | % |
---|---|---|
Endoscopic retrograde cholangiopancreatography (ERCP) ± sphincterotomy and delayed laparoscopic cholecystectomy | 183 | 6 |
Open intervention in urgent setting + antibiotics | 250 | 8 |
Conservative approach (antibiotics alone) and delayed laparoscopic cholecystectomy | 335 | 11 |
Laparoscopic intervention in urgent setting + antibiotics | 1474 | 51 |
Conservative approach (antibiotics alone) | 414 | 14 |
Interventional radiology/cholecystostomy/percutaneous drainage of gallbladder | 211 | 7 |
Conservative approach (antibiotics) + Cholecystectomy/ERCP + delayed laparoscopic cholecystectomy | 1 | 0 |
Conservative approach with antibiotic treatment-delayed intervention due to patient deterioration-percutaneous cholecystostomy | 1 | 0 |
2869 | 100 |
Management | Non-COVID group n = 2412 | COVID group n = 180 | p |
---|---|---|---|
Primary radiological diagnosis | 0.19 | ||
Ultrasound | 1604 (66.9%) | 110 (61.8%) | |
CT scan | 795 (33.1%) | 68 (38.2%) | |
Delay in intervention (h) | 45.9 (110.1) | 63.44 (201.4) | 0.89 |
Surgery | p < 0.0001 | ||
Laparoscopic total cholecystectomy | 1401 (76.6%) | 75 (58.1%) | |
Laparoscopic total cholecystectomy and intraoperative cholangiography | 135 (7.4%) | 10 (7.8%) | |
Laparoscopic partial cholecystectomy | 21 (1.1%) | 1 (0.8%) | |
Open total cholecystectomy | 123 (6.7%) | 29 (22.5%) | |
Open total cholecystectomy and intraoperative cholangiography | 17 (0.9%) | 2 (1.6%) | |
Open partial cholecystectomy after conversion | 18 (1%) | 1 (0.8%) | |
Open partial cholecystectomy | 17 (0.9%) | 2 (1.6%) | |
Open total cholecystectomy after conversion | 98 (5.4%) | 9 (0.7%) | |
Adequate source control | 2206 (94.6%) | 158 (93.5%) | 0.48 |
Adequate empirical antibiotics | 2317 (97.9%) | 169 (95.5%) | 0.48 |
Reoperation | 55 (2.6%) | 10 (14.6%) | 0.011 |
Strategy for reoperation | 0.11 | ||
Laparoscopy | 16 (23.9) | 2 (15.4) | |
On demand laparotomy | 16 (23.9) | 3 (23.1) | |
Planned laparotomy | 7 (10.4) | 5 (38.5) | |
Radiological intervention | 28 (41.8) | 3 (23.1) | |
Ventilation | 67 (2.8%) | 30 (16.8%) | p < 0.0001 |
Ventilation time (days) | 5 (6.6) | 4.55 (4.1) | 0.67 |
Parenteral nutrition | 145 (6.1%) | 39 (22.2%) | p < 0.0001 |
Parenteral nutrition time (days) | 4.01 (4.78) | 6.95 (6.5) | p = 0.001 |
Postoperative complications | Non-COVID group n = 2412 | COVID group n = 180 |
---|---|---|
Localized biliary peritonitis | 51 (2.1%) | 9 (5%) |
Pulmonary | 44 (1.82%) | 12 (6.6%) |
Wound infection | 39 (1.61%) | 15 (8.3%) |
Bleeding | 32 (1.32%) | 5 (2.7%) |
Intra-abdominal abscess | 26 (1.07%) | 1 (0.6%) |
Diffuse biliary peritonitis | 25 (1.03%) | 5 (2.7%) |
Biliary fistula | 19 (0.8%) | 2 (1.1% |
Sepsis/septic shock | 16 (0.07%) | 4 (2.2%) |
CBD stones | 14 (0.6%) | 1 (0.6%) |
Gastrointestinal | 9 (0.04%) | 1 (0.6%) |
Cardiac | 8 (0.03%) | 2 (1.1%) |
CBD injury | 7 (0.03%) | 1 (0.6%) |
Fever of unknown source | 7 (0.03%) | 2 (1.1%) |
Bowel perforation | 7 (0.03%) | 0 (0%) |
Localized collection | 5 (0.02%) | 0 (0%) |
Pancreatitis | 5 (0.02%) | 1 (0.6%) |
Renal | 3 (0.01%) | 1 (0.6%) |
Delerium/neurological | 3 (0.01%) | 3 (1.7%) |
Others | 14 (0.6%) | 1 (0.6%) |
Histopathology | Non-COVID group | COVID group |
---|---|---|
Acute cholecystitis | 899 (47.8%) | 58 (43%) |
Chronic cholecystitis | 489 (26%) | 18 (13.3%) |
Cholecystitis with necrosis/gangrene | 419 (22.3%) | 55 (40.7%) |
Acute on chronic cholecystitis | 46 (2.4%) | 1 (0.7%) |
Perforated cholecystitis/abscess formation | 11(0.6%) | 2 (0.15%) |
Malignancy | 10 (0.5%) | 1 (0.7%) |
Hydrocele | 2 (0.11%) | 0 (0%) |
Adenosis | 2 (0.11%) | 0 (0%) |
Normal | 1 (0.05%) | 0 (0%) |
Total | 1879 (100%) | 135 (100%) |