Pre-surgery age-adjusted Charlson Comorbidity Index is associated with worse outcomes in acute cholecystitis

Aldo Bonaventura; Irene Leale; Federico Carbone; Luca Liberale; Franco Dallegri; Fabrizio Montecucco; Giacomo Borgonovo

doi:10.1016/j.dld.2018.10.002

Pre-surgery age-adjusted Charlson Comorbidity Index is associated with worse outcomes in acute cholecystitis

Dig Liver Dis. 2019 Jun;51(6):858-863. doi: 10.1016/j.dld.2018.10.002. Epub 2018 Oct 11.

Authors

Aldo Bonaventura¹, Irene Leale², Federico Carbone³, Luca Liberale⁴, Franco Dallegri⁵, Fabrizio Montecucco⁶, Giacomo Borgonovo⁷

Affiliations

¹ First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy. Electronic address: aldobon85@gmail.com.
² HBP Surgery and Liver Transplant, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
³ First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.
⁴ First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy; Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland.
⁵ First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁶ First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy.
⁷ Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.

PMID: 30529046
DOI: 10.1016/j.dld.2018.10.002

Abstract

Background: Beneficial effects of cholecystectomy in acute cholecystitis (AC) might be weakened by complications. The age-adjusted Charlson Comorbidity Index (CCI) assesses disease relevance in the prediction of one-year mortality.

Aims: To evaluate whether age-adjusted CCI predicted complications (including surgical complications, intensive care unit [ICU] admission, and in-hospital death) among patients undergoing cholecystectomy for AC. Associations between age-adjusted CCI and the length of hospital stay have been also evaluated.

Methods: 271 patients were enrolled at Ospedale Policlinico San Martino (Genoa, Italy) between 2005 and 2013. Clinical data and blood samples were collected.

Results: Patients' median age was 67 years. They underwent more frequently video-laparoscopic cholecystectomy with a limited rate of conversion to open cholecystectomy. Surgical complications occurred in 23 patients (8.5%). 6 patients (2.2%) needed ICU admission, while death occurred in 4 patients (1.5%). According to the cut-off point identified by ROC curve, an age-adjusted CCI cut-off value of 5 was found predictive for in-hospital complications also when confounders were considered (OR 1.35, 95% CI 1.02-1.79, p = 0.035). No association between adjusted CCI and the length of hospital stay was found.

Conclusions: In patients surgically treated for AC, age-adjusted CCI could represent an additional tool, along with available risk scores, to help surgeons in choosing the best therapeutic option.

Keywords: Acute cholecystitis; Age-adjusted Charlson Comorbidity Index; Death; Elderly people; In-hospital complications.

MeSH terms

Aged
Cholecystectomy, Laparoscopic / adverse effects
Cholecystectomy, Laparoscopic / methods*
Cholecystitis, Acute / mortality
Cholecystitis, Acute / surgery*
Comorbidity
Female
Health Status Indicators
Hospital Mortality
Humans
Intensive Care Units / statistics & numerical data*
Italy / epidemiology
Length of Stay
Male
Middle Aged
Postoperative Complications / epidemiology*
ROC Curve
Retrospective Studies
Risk Assessment
Risk Factors
Survival Rate
Video-Assisted Surgery