Evidence map›Paper›PMID 39446173›Full record

ArticleLangenbeck's archives of surgery2024

Acute cholecystitis management at a tertiary care center: are we following current guidelines?

Andrea Spota, Amir Hassanpour, Eran Shlomovitz, David Gomez, Eisar Al-Sukhni

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Article in Langenbeck's archives of surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Andrea SpotaDepartment of Surgery, University Health Network, 200 Elizabeth St 10 Eaton North, Room 216, Toronto, ON, M5G 2C4, Canada. a.spota89@gmail.com.ORCID http://orcid.org/0000-0002-7058-5089
Amir HassanpourDepartment of Surgery, University Health Network, 200 Elizabeth St 10 Eaton North, Room 216, Toronto, ON, M5G 2C4, Canada.
Eran ShlomovitzDepartment of General Surgery, Department of Vascular Interventional Radiology, University Health Network, Toronto, ON, Canada.
David GomezTemerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Eisar Al-SukhniDepartment of Surgery, University Health Network, 200 Elizabeth St 10 Eaton North, Room 216, Toronto, ON, M5G 2C4, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAfter the Tokyo 2018 guidelines (TG2018) were published, evidence from the 2018 CHOCOLATE RCT supported early cholecystectomy for acute cholecystitis (AC), even in high-risk patients. This study aims to investigate AC management at our tertiary care center in the years following these publications.

methodsA retrospective cohort study was performed on patients admitted from 2018 to 2023. AC severity was graded using TG2018 definitions. Comorbidities were summarized using Charlson Comorbidity Index (CCI) and frailty using the 5-item modified Frailty Index (5mFI). Compliance with TG2018 recommendations for management strategy was investigated. Outcomes were compared between patients who underwent surgery versus non-operative management (NOM). Subset analysis based on patients' age, frailty, and comorbidities was performed.

resultsAmong 642 AC patients, 57% underwent cholecystectomy and 43% NOM (22% percutaneous cholecystostomy, 21% antibiotics only). NOM patients had greater length of stay (LOS), complications, deaths, readmissions, and discharge to nursing/rehab versus surgery patients. In 70% of patients managed non-operatively, TG2018 were not followed. Patients managed non-operatively despite TG2018 were more likely to undergo delayed cholecystectomy compared to those in whom guidelines were followed (17% vs. 4%). In subset analysis, healthy octogenarians were significantly less likely to be managed according to TG2018 (9.4%); patients undergoing surgery had a trend towards shorter LOS (3.1 vs. 4.8 days) than those managed non-operatively but no difference in other outcomes.

conclusionMost patients undergoing NOM could potentially undergo cholecystectomy if guidelines are considered. A more objective approach to risk assessment may optimize patient selection and outcomes.

Indexed as

CholecystectomyCholecystitis, AcuteGuideline AdherenceTertiary Care CentersAdultAgedAged, 80 and overFemaleHumansMaleMiddle AgedPractice Guidelines as TopicRetrospective StudiesAcute cholecystitisCholecystectomyCholecystostomyElderly.GuidelinesNon-operative management

Identifiers

PMID39446173

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.