[INTEGRAL ASSESSMENT OF RISK AND SEVERITY OF COMPLICATIONS OF SURGICAL TREATMENT FOR ACUTE CHOLECYSTITIS]

Acute cholecystitis (AC) is one of the most common surgical diagnoses in emergency setting. Despite its high incidence, there remains a range of treatment approaches. It is hard to compare different treatment options, and one of the reasons is that reporting of complications is often inconsistent and incomplete. This study aims to develop the Integral Complications Severity Index (ICSI) that takes into account all complications developed during and after surgery. We conducted a multicentric, retrospective cohort study of 754 patients. All of them had surgery for AC at eight hospitals in four cities of Russian Federation (Moscow, Yekaterinburg, Volgograd, and Kislovodsk) during 1-year period. To evaluate results of the surgical treatment we modified Accordion Severity Grading System by adding progressive scores for each grade of complication and taking into account not only all postoperative events but also all complications occurred during surgery and developed the ICSI. The Integral Complications Severity Index (ICSI) is calculated as sum of all complications multiplied by their corresponding scores (mild - 1, moderate -2, severe - 4, death - 8) and then this sum is divided by patients or procedures count. To evaluate surgical treatment schemes that involve multiple procedures (e.g., endoscopic sphincterotomy and laparoscopic cholecystectomy) ICSI of all procedures are summarized. The modified severity grade scale and ICSI can be used to evaluate and compare results and safety of various surgical procedures and their combinations taking into account all complications and their severity developed during and after surgery.