Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.
The ChoCO-W prospective observational global study. Does COVID-19 increase gangrenous cholecystitis? / DE SIMONE, Belinda; Abu-Zidan, Fikri M.; Elie, Chouillard; Salomone Di Saverio, ; Massimo, Sartelli; Mauro, Podda; Carlos Augusto Gomes, ; Moore, Ernest E.; Moug, Susan J.; Luca, Ansaloni; Yoram, Kluger; Federico, Coccolini; Aitor, Landaluce-Olavarria; Bego(~(n))a, Estraviz-Mateos; Ana, Uriguen-Etxeberria; Alessio, Giordano; Alfonso Palmieri Luna, ; Luz Adriana Hern('(a))ndez Am('(i))n, ; Adriana Mar('(i))a Palmieri Hern('(a))ndez, ; Amanda, Shabana; Zakaria Andee Dzulkarnaen, ; Muhammad Asyraf Othman, ; Mohamad Ikhwan Sani, ; Balla, Andrea; Rosa, Scaramuzzo; Pasquale, Lepiane; Andrea, Bottari; Fabio, Staderini; Fabio, Cianchi; Cavallaro, Andrea; Antonio, Zangh(`(i)); Alessandro, Cappellani; Roberto, Campagnacci; Maurizi, Angela; Mario, Martinotti; Annamaria, Ruggieri; Asri Che Jusoh, ; Karim Abdul Rahman, ; Zulkifli, Anis Suraya M.; Barbara, Petronio; Bel('(e))n, Mat('(i))as-Garc('(i))a; Ana, Quiroga-Valc('(a))rcel; Fernando, Mendoza-Moreno; Boyko, Atanasov; Fabio Cesare Campanile, ; Ilaria, Vecchioni; Luca, Cardinali; Grazia, Travaglini; Elisa, Sebastiani; Serge, Chooklin; Serhii, Chuklin; Pasquale, Cianci; Enrico, Restini; Sabino, Capuzzolo; Giuseppe, Curr(`(o)); Rosalinda, Filippo; Michele, Rispoli; Daniel, Aparicio-S('(a))nchez; Virginia Dur('(a))n Mu(~(n))('(o))z-Cruzado, ; Sandra Dios Barbeito, ; Samir, Delibegovic; Amar, Kesetovic; Diego, Sasia; Felice, Borghi; Giorgio, Giraudo; Diego, Visconti; Emanuele, Doria; Mauro, Santarelli; Davide, Luppi; Stefano, Bonilauri; Ugo, Grossi; Giacomo, Zanus; Alberto, Sartori; Giacomo, Piatto; DE LUCA, Maurizio; Vita, Domenico; Luigi, Conti; Patrizio, Capelli; Gaetano Maria Cattaneo, ; Athanasios, Marinis; Styliani-Aikaterini, Vederaki; Mehmet, Bayrak; Yasemin, Alt(i)ntas; Mustafa Yener Uzunoglu, ; Iskender Eren Demirbas, ; Yuksel, Altinel; Serhat, Meric; Yunus Emre Aktimur, ; Derya Salim Uymaz, ; Nail, Omarov; Ibrahim, Azamat; Eftychios, Lostoridis; Eleni-Aikaterini, Nagorni; Antonio, Pujante; Gabriele, Anania; Cristina, Bombardini; Francesco, Bagolini; Emre, Gonullu; Baris, Mantoglu; Recayi, Capoglu; Stefano, Cappato; Elena, Muzio; Elif, Colak; Suleyman, Polat; Zehra Alan Koylu, ; Fatih, Altintoprak; Zülfü, Bayhan; Emrah, Akin; Enrico, Andolfi; Sulce, Rezart; Jae Il Kim, ; Sung Won Jung, ; Yong Chan Shin, ; Octavian, Enciu; Elena Adelina Toma, ; Fabio, Medas; Gian Luigi Canu, ; Federico, Cappellacci; Fabrizio, D'Acapito; Giorgio, Ercolani; Leonardo, Solaini; Francesco, Roscio; CLERICI BAGOZZI, Federico; Roberta, Gelmini; Francesco, Serra; Elena Giulia Rossi, ; Francesco, Fleres; Guglielmo, Clarizia; Alessandro, Spolini; Francesco, Ferrara; Gabriela, Nita; Jlenia, Sarnari; Mahir, Gachabayov; Abakar, Abdullaev; Poillucci, Gaetano; Gian Marco Palini, ; Simone, Veneroni; Gianluca, Garulli; Micaela, Piccoli; Gianmaria Casoni Pattacini, ; Francesca, Pecchini; Giulio, Argenio; Mariano Fortunato Armellino, ; Giuseppe, Brisinda; Tedesco, Silvia; Fransvea, Pietro; Giuseppe, Ietto; Caterina, Franchi; Giulio, Carcano; Gennaro, Martines; Trigiante, Giuseppe; Giulia, Negro; Gustavo Machain Vega, ; Agust('(i))n Rodr('(i))guez Gonz('(a))lez, ; Leonardo, Ojeda; Gaetano, Piccolo; Andrea, Bondurri; Anna, Maffioli; Claudio, Guerci; Boo Han Sin, ; Zamri, Zuhdi; Azlanudin, Azman; Hussam, Mousa; Shadi al Bahri, ; Goran, Augustin; Ivan, Romic; Trpimir, Moric; Ioannis, Nikolopoulos; Andreuccetti, Jacopo; Giusto, Pignata; Rossella, D'Alessio; Jakub, Kenig; Urszula, Skorus; Gustavo Pereira Fraga, ; Elcio Shiyoiti Hirano, ; Jackson Vin('(i))cius de Lima Bertuol, ; Arda, Isik; Eray, Kurnaz; Mohammad Sohail Asghar, ; Ameer, Afzal; Ali, Akbar; Taxiarchis Konstantinos Nikolouzakis, ; Konstantinos, Lasithiotakis; Emmanuel, Chrysos; Koray, Das; Nazmi, Özer; Ahmet, Seker; Mohamed, Ibrahim; Hamid, Hytham K. S.; Ahmed, Babiker; Konstantinos, Bouliaris; George, Koukoulis; Chrysoula-Christina, Kolla; Lucchi, Andrea; Laura, Agostinelli; Antonio, Taddei; Laura, Fortuna; Carlotta, Agostini; Leo, Licari; Simona, Viola; Cosimo, Callari; Letizia, Laface; Emmanuele, Abate; Massimiliano, Casati; Alessandro, Anastasi; Giuseppe, Canonico; Linda, Gabellini; Lorenzo, Tosi; Anna, Guariniello; Federico, Zanzi; Lovenish, Bains; Larysa, Sydorchuk; Oksana, Iftoda; Andrii, Sydorchuk; Michele, Malerba; Federico, Costanzo; Raffaele, Galleano; Michela, Monteleone; Andrea, Costanzi; Carlo, Riva; Maciej, Wal(k(e))dziak; (z))ykowski, Andrzej Kwiatkowski (L)ukasz Czy(.; Piotr, Major; Marcin, Strza(l)ka; Maciej, Matyja; Michal, Natkaniec; Maria Rosaria Valenti, ; Maria Domenica Pia Di Vita, ; Maria, Sotiropoulou; Stylianos, Kapiris; Damien, Massalou; Massimiliano, Veroux; Alessio, Volpicelli; Rossella, Gioco; Matteo, Uccelli; Marta, Bonaldi; Stefano, Olmi; Matteo, Nardi; Livadoti, Giada; Cristian, Mesina; Theodor Viorel Dumitrescu, ; Mihai Calin Ciorbagiu, ; Michele, Ammendola; Giorgio, Ammerata; Roberto, Romano; Mihail, Slavchev; Misiakos, Evangelos P.; Emmanouil, Pikoulis; Dimitrios, Papaconstantinou; Mohamed, Elbahnasawy; Sherief, Abdel-elsalam; Felsenreich, Daniel M.; Julia, Jedamzik; Michalopoulos, Nikolaos V.; Sidiropoulos, Theodoros A.; Maria, Papadoliopoulou; Nicola, Cillara; Antonello, Deserra; Alessandro, Cannavera; Ionu(c(t)), Negoi; Dimitrios, Schizas; Athanasios, Syllaios; Ilias, Vagios; Stavros, Gourgiotis; Nick, Dai; Rekha, Gurung; Marcus, Norrey; Antonio, Pesce; Carlo Vittorio Feo, ; Nicolo', Fabbri; Nikolaos, Machairas; Panagiotis, Dorovinis; Keramida, Myrto D.; Francesk, Mulita; Georgios Ioannis Verras, ; Michail, Vailas; Omer, Yalkin; Nidal, Iflazoglu; Direnc, Yigit; Oussama, Baraket; Karim, Ayed; Mohamed hedi Ghalloussi, ; Parmenion, Patias; Georgios, Ntokos; Razrim, Rahim; Miklosh, Bala; Asaf, Kedar; Sawyer, Robert G.; Anna, Trinh; Kelsey, Miller; Ruslan, Sydorchuk; Ruslan, Knut; Oleksandr, Plehutsa; Rumeysa Kevser Liman, ; Zeynep, Ozkan; Saleh Abdel Kader, ; Sanjay, Gupta; Monika, Gureh; Sara, Saeidi; Mohsen, Aliakbarian; Amin, Dalili; Tomohisa, Shoko; Mitsuaki, Kojima; Raira, Nakamoto; Semra Demirli Atici, ; Gizem Kilinc Tuncer, ; Tayfun, Kaya; Delis, Spiros G.; Stefano, Rossi; Biagio, Picardi; ROSSI DEL MONTE, Simone; Tania, Triantafyllou; Dimitrios, Theodorou; Tadeja, Pintar; Jure, Salobir; Manatakis, Dimitrios K.; Nikolaos, Tasis; Vasileios, Acheimastos; Orestis, Ioannidis; Lydia, Loutzidou; Savvas, Symeonidis; Tiago Correia de S('(a)), ; M('(o))nica, Rocha; Tommaso, Guagni; Desir('(e)), Pantalone; Gherardo, Maltinti; Vladimir, Khokha; Wafaa, Abdel-elsalam; Basma, Ghoneim; Jos('(e)) Antonio L('(o))pez-Ruiz, ; Yasin, Kara; Syaza, Zainudin; Firdaus, Hayati; Nornazirah, Azizan; Victoria Tan Phooi Khei, ; Rebecca Choy Xin Yi, ; Harivinthan, Sellappan; Zaza, Demetrashvili; Nika, Lekiashvili; Ana, Tvaladze; Froiio, Caterina; Bernardi, Daniele; Luigi, Bonavina; Angeles, Gil-Olarte; Sebastiano, Grassia; Estela, Romero-Vargas; Francesco, Bianco; Gumbs, Andrew A.; Agron, Dogjani; Ferdinando, Agresta; Andrey, Litvin; Balogh, Zsolt J.; George, Gendrikson; Costanza, Martino; Dimitrios, Damaskos; Nikolaos, Pararas; Andrew, Kirkpatrick; Mikhail, Kurtenkov; Felipe Couto Gomes, ; Adolfo, Pisanu; Oreste, Nardello; Fabrizio, Gambarini; Hager, Aref; Nicola de' Angelis, ; Vanni, Agnoletti; Biondi, ANTONIO GIUESEPPE; Marco, Vacante; Giulia, Griggio; Roberta, Tutino; Marco, Massani; Bisetto, Giovanni; Savino, Occhionorelli; Dario, Andreotti; Domenico, Lacavalla; Biffl, Walter L.; Fausto, Catena. - In: WORLD JOURNAL OF EMERGENCY SURGERY. - ISSN 1749-7922. - 17:1(2022). [10.1186/s13017-022-00466-4]
The ChoCO-W prospective observational global study. Does COVID-19 increase gangrenous cholecystitis?
Belinda De Simone;Andrea Balla;Andrea Cavallaro;Angela Maurizi;Maurizio De Luca;Domenico Vita;Federico Clerici;Gaetano Poillucci;Silvia Tedesco;Pietro Fransvea;Giuseppe Trigiante;Jacopo Andreuccetti;Andrea Lucchi;Federico Costanzo;Giada Livadoti;Simone Rossi del Monte;Caterina Froiio;Daniele Bernardi;Antonio Biondi;Giovanni Bisetto;
2022
Abstract
Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.| File | Dimensione | Formato | |
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