Gallbladder perforation: morbidity, mortality and preoperative risk prediction

Area of Science:

• Surgical Gastroenterology
• Critical Care Medicine
• Clinical Epidemiology

Background:

• Gallbladder perforation (GBP) is a serious complication of acute cholecystitis, affecting 2-11% of patients.
• GBP significantly increases patient morbidity and mortality rates.

Purpose of the Study:

• To identify factors associated with morbidity and mortality in patients with GBP.
• To evaluate the accuracy of preoperative risk prediction scores for GBP.

Main Methods:

• Retrospective review of 1,033 patients undergoing cholecystectomy for acute cholecystitis (2002-2012).
• Analysis of preoperative, intraoperative, and postoperative data using univariate and multivariate statistics.
• Comparison of ASA, POSSUM, and APACHE II scores using receiver-operating characteristics analysis.

Main Results:

• 137 patients (12.4%) had GBP, with morbidity at 57.7% and mortality at 9.5%.
• Multivariate analysis identified preoperative albumin, open surgery, and preoperative sepsis as factors associated with complications.
• Preoperative sepsis was the sole independent predictor of hospital mortality (OR 9.127).
• POSSUM and APACHE II scores demonstrated superior accuracy over ASA score for risk prediction.

Conclusions:

• Preoperative severe sepsis is a critical determinant of postoperative morbidity and mortality in GBP.
• Identifying patients with severe sepsis is crucial for directing them to the highest level of care.
• Accurate risk prediction scores like POSSUM and APACHE II can aid in managing GBP patients.