Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines

Abstract Background Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment early laparoscopic cholecystectomy; however, Tokyo Guidelines (TG) advocate for different initial treatments some subgroups of patients without a strong evidence that all will benefit from them. There no clear consensus literature about who unfit patient treatment. primary aim study to identify risk factors mortality ACC and compare them with classification. Methods Retrospective unicentric cohort emergently admitted during 1 January 2011 31 December 2016. comprised 963 patients. Primary outcome was after diagnosis. A propensity score method used avoid confounding comparing non-surgical Results overall 3.6%. Mortality associated older age (68 + IQR 27 vs. 83 5.5; P = 0.001) higher Charlson Comorbidity Index (3.5 5.3 0 2; 0.001). logistic regression model isolated four (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7–12.8 0.001), dementia 4.12; 1.34–12.7, > 80 years 1.12: 1.02–1.21, need preoperative vasoactive amines 9.9: 3.5–28.3, which predicted 92% receiver operating characteristic curve yielded an area 88% significantly 68% ( 0.003) TG When selected using matching same morbidity severity ACC, group. (26.2% 10.5%). Conclusions treated ACME identifies high-risk validation prospective multicenter population could allow us create new alternative guideline treating ACC. Trial registration Retrospectively registered recorded Clinical Trials. NCT04744441