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?

Feo C. V.;Occhionorelli S.;
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.
2022
De Simone, B.; Abu-Zidan, F. M.; Chouillard, E.; Di Saverio, S.; Sartelli, M.; Podda, M.; Gomes, C. A.; Moore, E. E.; Moug, S. J.; Ansaloni, L.; Kluger, Y.; Coccolini, F.; Landaluce-Olavarria, A.; Estraviz-Mateos, B.; Uriguen-Etxeberria, A.; Giordano, A.; Luna, A. P.; Amin, L. A. H.; Hernandez, A. M. P.; Shabana, A.; Dzulkarnaen, Z. A.; Othman, M. A.; Sani, M. I.; Balla, A.; Scaramuzzo, R.; Lepiane, P.; Bottari, A.; Staderini, F.; Cianchi, F.; Cavallaro, A.; Zanghi, A.; Cappellani, A.; Campagnacci, R.; Maurizi, A.; Martinotti, M.; Ruggieri, A.; Jusoh, A. C.; Rahman, K. A.; Zulkifli, A. S. M.; Petronio, B.; Matias-Garcia, B.; Quiroga-Valcarcel, A.; Mendoza-Moreno, F.; Atanasov, B.; Campanile, F. C.; Vecchioni, I.; Cardinali, L.; Travaglini, G.; Sebastiani, E.; Chooklin, S.; Chuklin, S.; Cianci, P.; Restini, E.; Capuzzolo, S.; Curro, G.; Filippo, R.; Rispoli, M.; Aparicio-Sanchez, D.; Munoz-Cruzado, V. D.; Barbeito, S. D.; Delibegovic, S.; Kesetovic, A.; Sasia, D.; Borghi, F.; Giraudo, G.; Visconti, D.; Doria, E.; Santarelli, M.; Luppi, D.; Bonilauri, S.; Grossi, U.; Zanus, G.; Sartori, A.; Piatto, G.; De Luca, M.; Vita, D.; Conti, L.; Capelli, P.; Cattaneo, G. M.; Marinis, A.; Vederaki, S. -A.; Bayrak, M.; Altintas, Y.; Uzunoglu, M. Y.; Demirbas, I. E.; Altinel, Y.; Meric, S.; Aktimur, Y. E.; Uymaz, D. S.; Omarov, N.; Azamat, I.; Lostoridis, E.; Nagorni, E. -A.; Pujante, A.; Anania, G.; Bombardini, C.; Bagolini, F.; Gonullu, E.; Mantoglu, B.; Capoglu, R.; Cappato, S.; Muzio, E.; Colak, E.; Polat, S.; Koylu, Z. A.; Altintoprak, F.; Bayhan, Z.; Akin, E.; Andolfi, E.; Rezart, S.; Kim, J. I.; Jung, S. W.; Shin, Y. C.; Enciu, O.; Toma, E. A.; Medas, F.; Canu, G. L.; Cappellacci, F.; D'Acapito, F.; Ercolani, G.; Solaini, L.; Roscio, F.; Clerici, F.; Gelmini, R.; Serra, F.; Rossi, E. G.; Fleres, F.; Clarizia, G.; Spolini, A.; Ferrara, F.; Nita, G.; Sarnari, J.; Gachabayov, M.; Abdullaev, A.; Poillucci, G.; Palini, G. M.; Veneroni, S.; Garulli, G.; Piccoli, M.; Pattacini, G. C.; Pecchini, F.; Argenio, G.; Armellino, M. F.; Brisinda, G.; Tedesco, S.; Fransvea, P.; Ietto, G.; Franchi, C.; Carcano, G.; Martines, G.; Trigiante, G.; Negro, G.; Vega, G. M.; Gonzalez, A. R.; Ojeda, L.; Piccolo, G.; Bondurri, A.; Maffioli, A.; Guerci, C.; Sin, B. H.; Zuhdi, Z.; Azman, A.; Mousa, H.; al Bahri, S.; Augustin, G.; Romic, I.; Moric, T.; Nikolopoulos, I.; Andreuccetti, J.; Pignata, G.; D'Alessio, R.; Kenig, J.; Skorus, U.; Fraga, G. P.; Hirano, E. S.; de Lima Bertuol, J. V.; Isik, A.; Kurnaz, E.; Asghar, M. S.; Afzal, A.; Akbar, A.; Nikolouzakis, T. K.; Lasithiotakis, K.; Chrysos, E.; Das, K.; Ozer, N.; Seker, A.; Ibrahim, M.; Hamid, H. K. S.; Babiker, A.; Bouliaris, K.; Koukoulis, G.; Kolla, C. -C.; Lucchi, A.; Agostinelli, L.; Taddei, A.; Fortuna, L.; Agostini, C.; Licari, L.; Viola, S.; Callari, C.; Laface, L.; Abate, E.; Casati, M.; Anastasi, A.; Canonico, G.; Gabellini, L.; Tosi, L.; Guariniello, A.; Zanzi, F.; Bains, L.; Sydorchuk, L.; Iftoda, O.; Sydorchuk, A.; Malerba, M.; Costanzo, F.; Galleano, R.; Monteleone, M.; Costanzi, A.; Riva, C.; Waledziak, M.; Kwiatkowski, A.; Czyzykowski, L.; Major, P.; Strzalka, M.; Matyja, M.; Natkaniec, M.; Valenti, M. R.; Di Vita, M. D. P.; Sotiropoulou, M.; Kapiris, S.; Massalou, D.; Veroux, M.; Volpicelli, A.; Gioco, R.; Uccelli, M.; Bonaldi, M.; Olmi, S.; Nardi, M.; Livadoti, G.; Mesina, C.; Dumitrescu, T. V.; Ciorbagiu, M. C.; Ammendola, M.; Ammerata, G.; Romano, R.; Slavchev, M.; Misiakos, E. P.; Pikoulis, E.; Papaconstantinou, D.; Elbahnasawy, M.; Abdel-elsalam, S.; Felsenreich, D. M.; Jedamzik, J.; Michalopoulos, N. V.; Sidiropoulos, T. A.; Papadoliopoulou, M.; Cillara, N.; Deserra, A.; Cannavera, A.; Negoi, I.; Schizas, D.; Syllaios, A.; Vagios, I.; Gourgiotis, S.; Dai, N.; Gurung, R.; Norrey, M.; Pesce, A.; Feo, C. V.; Fabbri, N.; Machairas, N.; Dorovinis, P.; Keramida, M. D.; Mulita, F.; Verras, G. I.; Vailas, M.; Yalkin, O.; Iflazoglu, N.; Yigit, D.; Baraket, O.; Ayed, K.; Ghalloussi, M.; Patias, P.; Ntokos, G.; Rahim, R.; Bala, M.; Kedar, A.; Sawyer, R. G.; Trinh, A.; Miller, K.; Sydorchuk, R.; Knut, R.; Plehutsa, O.; Liman, R. K.; Ozkan, Z.; Kader, S. A.; Gupta, S.; Gureh, M.; Saeidi, S.; Aliakbarian, M.; Dalili, A.; Shoko, T.; Kojima, M.; Nakamoto, R.; Atici, S. D.; Tuncer, G. K.; Kaya, T.; Delis, S. G.; Rossi, S.; Picardi, B.; del Monte, S. R.; Triantafyllou, T.; Theodorou, D.; Pintar, T.; Salobir, J.; Manatakis, D. K.; Tasis, N.; Acheimastos, V.; Ioannidis, O.; Loutzidou, L.; Symeonidis, S.; de Sa, T. C.; Rocha, M.; Guagni, T.; Pantalone, D.; Maltinti, G.; Khokha, V.; Abdel-elsalam, W.; Ghoneim, B.; Lopez-Ruiz, J. A.; Kara, Y.; Zainudin, S.; Hayati, F.; Azizan, N.; Khei, V. T. P.; Yi, R. C. X.; Sellappan, H.; Demetrashvili, Z.; Lekiashvili, N.; Tvaladze, A.; Froiio, C.; Bernardi, D.; Bonavina, L.; Gil-Olarte, A.; Grassia, S.; Romero-Vargas, E.; Bianco, F.; Gumbs, A. A.; Dogjani, A.; Agresta, F.; Litvin, A.; Balogh, Z. J.; Gendrikson, G.; Martino, C.; Damaskos, D.; Pararas, N.; Kirkpatrick, A.; Kurtenkov, M.; Gomes, F. C.; Pisanu, A.; Nardello, O.; Gambarini, F.; Aref, H.; Angelis, N.; Agnoletti, V.; Biondi, A.; Vacante, M.; Griggio, G.; Tutino, R.; Massani, M.; Bisetto, G.; Occhionorelli, S.; Andreotti, D.; Lacavalla, D.; Biffl, W. L.; Catena, F.
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