Observational studyWorld journal of emergency surgery : WJES2023
Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study.
Observational study in World journal of emergency surgery : WJES, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04995380 (Validation and Comparison of Scores for Prediction of RIsk for Post-operative Major Morbidity After Cholecystectomy in Acute Calculous Cholecystitis), which is not on this map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Validation and Comparison of Scores for Prediction of RIsk for Post-operative Major Morbidity After Cholecystectomy in Acute Calculous Cholecystitis: Protocol for a Prospective Multicenter Observational Study (SPRIMACC)
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Systematic review on the use of artificial intelligence to identify anatomical structures during laparoscopic cholecystectomy: a tool towards the future.Langenbeck's archives of surgery · 2025Pooled it
- Explainable early prediction of short-term severe deterioration in gallstone-related biliary disease using MIMIC-IV, eICU, and local real-world data.BMC gastroenterology · 2026Article
- Predicting Postoperative Complications After Cholecystectomy for Acute Cholecystitis: Comparative Performance of Disease-Specific and General Prognostic Scores.Journal of clinical medicine · 2026Article
- Comparative Early Postoperative Outcomes in Acute Calculous vs. Acute Acalculous Cholecystitis: A Retrospective Analysis.Medicina (Kaunas, Lithuania) · 2026Article
- Interventional management of acute perforated cholecystitis: When is percutaneous transhepatic cholecystostomy a reasonable therapeutic option?World journal of gastrointestinal surgery · 2026Article
- Is there a difference in textbook outcomes of emergency cholecystectomy in older patients compared with younger patients?World journal of emergency surgery : WJES · 2025Article
- Age Is Not So Important for Risk Stratification in Early Cholecystectomy for Acute Calculous Cholecystitis: A Post-Hoc Analysis of the SPRiMACC Study Database.Medicina (Kaunas, Lithuania) · 2025Observational
- Mortality and cardiovascular disease after cholecystectomy in type 2 diabetes: A nationwide longitudinal cohort study.Journal of hepato-biliary-pancreatic sciences · 2025Article
- Time from drainage to surgery is an independent predictor of morbidity for moderate-to-severe acute cholecystitis: a multivarirble analysis of 259 patients.BMC surgery · 2024Article
- Clinical update on acute cholecystitis and biliary pancreatitis: between certainties and grey areas.EClinicalMedicine · 2024Review
- Improving early cholecystectomy rate in acute cholecystitis with an evidence-based local multidisciplinary protocol and a surgical audit: single-center experience through an Acute Care Surgery Division.Langenbeck's archives of surgery · 2024Article
- Textbook outcome in urgent early cholecystectomy for acute calculous cholecystitis: results post hoc of the S.P.Ri.M.A.C.C study.World journal of emergency surgery : WJES · 2024Observational
- Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma.World journal of emergency surgery : WJES · 2023Article
- Timing of Early Cholecystectomy for Acute Calculous Cholecystitis: A Multicentric Prospective Observational Study.Healthcare (Basel, Switzerland) · 2023Article
- Gaps and insights toward evidence-based management for acute cholecystitis patients at high surgical risk.Endoscopic ultrasoundReview
- The i-EUS consensus on EUS-guided gallbladder drainage: A 3-step modified Delphi approach.Endoscopic ultrasoundArticle
Corrections and comments
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Authors and funding
29 authors at 14 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLess invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models.
methodThe S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models-POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade-receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities.
resultsA 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a 'Chole-POSSUM' score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96-97% negative predictive value for major complications.
conclusionsThe Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action.
trial registrationClinicalTrial.gov NCT04995380.
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