1. Multicentre cohort study of acute cholecystitis management during the COVID-19 pandemic
- Author
-
Elías Rodríguez Cuéllar, Javier Martínez Caballero, Juan José Pérez Alegre, Arantxa Villadoniga, María Díaz, David Alias Jiménez, Víctor Vaello Jodra, David Pérez, Monica Galan Martín, Rosario San Román Romanillos, Mariana García Virosta, María de Mar Pardo de Lama, Marcello Di Martino, Jenny Guevara-Martínez, Marta de la Fuente Bartolomé, Roberto Martínez Fernández, Jana Dziakova, María Gutiérrez Samaniego, Cristina Pérez Algar, Luis de Nicolás Navas, Ángela de la Hoz Rodríguez, Lucía González González, Eduardo Ferrero Herrero, Daniel Sánchez López, and Javier García-Quijada García
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Cholecystitis, Acute ,Comorbidity ,Critical Care and Intensive Care Medicine ,Conservative Treatment ,Risk Assessment ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Hospital-acquired infection ,medicine ,Infection control ,Humans ,Orthopedics and Sports Medicine ,Cholecystectomy ,education ,030222 orthopedics ,education.field_of_study ,Cross Infection ,Infection Control ,business.industry ,SARS-CoV-2 ,Mortality rate ,COVID-19 ,030208 emergency & critical care medicine ,Length of Stay ,Middle Aged ,medicine.disease ,Anti-Bacterial Agents ,Acute cholecystitis ,Outcome and Process Assessment, Health Care ,Spain ,Emergency Medicine ,Drainage ,Surgery ,Female ,Original Article ,Risk assessment ,business ,Cohort study - Abstract
Purpose To analyse acute cholecystitis (AC) management during the first pandemic outbreak after the recommendations given by the surgical societies estimating: morbidity, length of hospital stay, mortality and hospital-acquired SARS-CoV-2 infection rate. Methods Multicentre-combined (retrospective–prospective) cohort study with AC patients in the Community of Madrid between 1st March and 30th May 2020. 257 AC patients were involved in 16 public hospital. Multivariant binomial logistic regression (MBLR) was applied to mortality. Results Of COVID-19 patients, 30 were diagnosed at admission and 12 patients were diagnosed during de admission or 30 days after discharge. In non-COVID-19 patients, antibiotic therapy was received in 61.3% of grade I AC and 40.6% of grade II AC. 52.4% of grade III AC were treated with percutaneous drainage (PD). Median hospital stay was 5 [3–8] days, which was higher in the non-surgical treatment group with 7.51 days (p 0.05). In patients with hospital-acquired SARS-CoV-2 infection, 91.7% of grade I–II AC were treated with non-surgical treatment (p = 0.037), with a median hospital stay of 16 [4–21] days and a 18.2% mortality rate (p > 0.05). Hospital-acquired infection risk when hospital stay is > 7 days is OR 4.7, CI 95% (1.3–16.6), p = 0.009. COVID-19 mortality rate was 11.9%, AC severity adjusted OR 5.64 (CI 95% 1.417–22.64). In MBLR analysis, age (OR 1.15, CI 95% 1.02–1.31), SARS-CoV-2 infection (OR 14.49, CI 95% 1.33–157.81), conservative treatment failure (OR 8.2, CI 95% 1.34–50.49) and AC severity were associated with an increased odd of mortality. Conclusion In our population, during COVID-19 pandemic, there was an increase of non-surgical treatment which was accompanied by an increase of conservative treatment failure, morbidity and hospital stay length which may have led to an increased risk hospital-acquired SARS-CoV-2 infection. Age, SARS-CoV-2 infection, AC severity and conservative treatment failure were mortality risk factors.
- Published
- 2020