Background. The impact of diabetes and cardiovascular comor- bidity on laparoscopic cholecystectomy has been long debated, evalua- ting them as risk factors for conversion to an open procedure especially in patients with acute cholecystitis: an “early” procedure, as suggested by 2013 Tokyo guidelines, has been compared to a “very delayed” one in patients under anticoagulant/antiplatelet therapy or treated for dia- betes and referred by medical wards to surgery after the acute period. Methods. We selected 240 patients operated for acute cholecystitis by laparoscopy over the last 4 years at St. Orsola University Hospital- Bologna and Umberto I University Hospital-Rome, comparing 98 diabetic/cardiovascular patients versus 142 subjects as control group: the selection was based on operative timing, “early” (73 patients trea- ted within 3 days) and “very delayed” (167 patients operated after 6 weeks). Results. In the “early” subgroup there was no difference compa- ring diabetic/cardiovascular patients (31 pts) versus control group (42 pts) while in the “very delayed” subgroup among diabetic/cardiovascu- lar patients (67 pts) there was significantly male predominance, ASA III/IV prevalence and less positive imaging findings versus control group (100 pts). In both subgroups, the conversion rate was significan- tly higher for diabetic/cardiovascular patients (“early”=25.8% and “very delayed”=8.95%) compared to control groups (“early”=4.76% and “very delayed”=1%), showing a trend (p=0.058) towards an in- creased conversion rate in the early approach among diabetic/cardio- vascular group. Conclusions. Our study showed a significantly increased conver- sion rate to an open cholecystectomy for diabetic/cardiovascular pa- tients affected by cholecystitis, especially within 3 days by the acute epi- sode.

Impact of cardiovascular/diabetic comorbidity on conversion rate during laparoscopic cholecystectomy for acute cholecystitis. A multi-center study on early versus very delayed approach

Panarese, A;
2019

Abstract

Background. The impact of diabetes and cardiovascular comor- bidity on laparoscopic cholecystectomy has been long debated, evalua- ting them as risk factors for conversion to an open procedure especially in patients with acute cholecystitis: an “early” procedure, as suggested by 2013 Tokyo guidelines, has been compared to a “very delayed” one in patients under anticoagulant/antiplatelet therapy or treated for dia- betes and referred by medical wards to surgery after the acute period. Methods. We selected 240 patients operated for acute cholecystitis by laparoscopy over the last 4 years at St. Orsola University Hospital- Bologna and Umberto I University Hospital-Rome, comparing 98 diabetic/cardiovascular patients versus 142 subjects as control group: the selection was based on operative timing, “early” (73 patients trea- ted within 3 days) and “very delayed” (167 patients operated after 6 weeks). Results. In the “early” subgroup there was no difference compa- ring diabetic/cardiovascular patients (31 pts) versus control group (42 pts) while in the “very delayed” subgroup among diabetic/cardiovascu- lar patients (67 pts) there was significantly male predominance, ASA III/IV prevalence and less positive imaging findings versus control group (100 pts). In both subgroups, the conversion rate was significan- tly higher for diabetic/cardiovascular patients (“early”=25.8% and “very delayed”=8.95%) compared to control groups (“early”=4.76% and “very delayed”=1%), showing a trend (p=0.058) towards an in- creased conversion rate in the early approach among diabetic/cardio- vascular group. Conclusions. Our study showed a significantly increased conver- sion rate to an open cholecystectomy for diabetic/cardiovascular pa- tients affected by cholecystitis, especially within 3 days by the acute epi- sode.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11697/140226
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