Management of acute cholecystitis in a medium-sized centre

Abstract

Background: Cholelithiasis is a frequent gastrointestinal disease, and acute cholecystitis (AC) is one of its most frequent complication. Before Tokyo Guidelines (TG) for AC management, no consensus on how to diagnose and treat these patients was established. Despite having a low mortality rate, a meta-analysis reported a 3% of mortality before guidelines implementation. After TG, no studies clarified its improvement in terms of mortality and only few were carried out. Those studies demonstrated only a reduced length of stay in comparison. Authors concluded that further studies are needed. Additionally, no studies collecting AC data were found in our region. Finally, due to its chronic condition, cholelithiasis is a high burden disease all over, and AC management is expensive as well. This study may have an economic impact if it reveals that we could be more efficient treating these patients. Thus, this study pretends to analyse how our medium-sized centre manages AC, to compare our results with those obtained during pre-TG era, to create a large data base and finally to know which impact had TG on AC management. Objective: This study aims to find the mortality rate of patients diagnosed and treated of AC according to TG recommendations at General Surgery department of our centre. We expect a 2’5% mortality rate, demonstrating a better survival rate than before TG era. Length of stay and surgical-related complications will be also evaluated. Design: Cross-sectional study conducted in a medium-sized centre between January 2016 and July 2017. Methods: We will need a sample of 82 patients if we expect a 2’5% of mortality rate. Non-probabilistic, consecutive method of recruitment will be used. TG diagnostic criteria will be applied for these patients and they will be categorized into three severity groups with different treatment per each one. Statistical analysis will be adjusted by possible confounding variables