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Clinical characteristics and management of acute cholecystitis after cardiovascular surgery
Koya Yasukawa1, Akira Shimizu1, Koji Kubota1
1Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Insights
Acute cholecystitis after cardiovascular surgery presents with higher rates of severe, acalculous, and gangrenous disease. Prompt surgical treatment is crucial for favorable outcomes in these complex cases.
Area of Science:
- Surgery
- Gastroenterology
- Critical Care Medicine
Background:
- Acute cholecystitis (AC) is a serious complication following cardiovascular surgery (CS).
- Understanding the clinical characteristics of AC post-CS is vital for effective management.
- Previous studies have not fully delineated the specific features of AC in CS patients.
Purpose of the Study:
- To characterize the clinical presentation of acute cholecystitis in patients who have undergone cardiovascular surgery.
- To compare AC in patients with and without a history of cardiovascular surgery.
- To propose an optimal treatment strategy for AC following CS.
Main Methods:
- Retrospective review of 88 patients undergoing cholecystectomy for AC (grades II or III) between 2008 and 2019.
- Patients were divided into two groups: AC after CS (Group CS, n=37) and AC without CS (Group non-CS, n=51).
- Clinical data, including AC grade, etiology, bacterial cultures, and outcomes, were analyzed.
Main Results:
- Grade III AC was significantly more common in Group CS (73% vs 41%).
- Acalculous (81% vs 39%) and gangrenous (86% vs 59%) AC were significantly higher in Group CS.
- Higher rates of positive bacterial cultures, including multidrug-resistant organisms, were observed in Group CS; morbidity and mortality were comparable between groups.
Conclusions:
- Acute cholecystitis after cardiovascular surgery exhibits distinct, more severe characteristics.
- Percutaneous drainage may not be sufficient, often requiring subsequent cholecystectomy.
- Timely surgical intervention for AC after CS is recommended to ensure optimal patient outcomes.
Background:
Acute cholecystitis (AC) is a severe complication after cardiovascular surgery (CS). The purpose of this study was to delineate the clinical picture of AC after CS to propose an optimal treatment strategy.
Methods:
We retrospectively reviewed the records of 88 patients who underwent cholecystectomy for grade II or III AC between 2008 and 2019 (AC after CS: Group CS, n = 37; AC without CS: Group non-CS, n = 51).
Results:
The proportion of grade III AC in Group CS was significantly higher than that in Group non-CS (73% vs 41%, P = .005). Furthermore, the incidences of acalculous (81% vs 39%) and gangrenous (86% vs 59%) AC were significantly higher in Group CS (P < .05 for both). In Group CS, 11 patients had had percutaneous drainage preceding surgery, for whom cholecystectomy within 3 days was eventually necessary because their general condition was exacerbated. The incidence of a positive culture from the gallbladder bile and blood samples of Group CS were significantly higher (P < .05 for both); multidrug-resistant bacteria were detected at an especially high rate. However, the morbidity rate was comparable, and zero mortality was achieved in both groups.
Conclusions:
Timely surgical intervention without hesitation is recommended for AC after CS.
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