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Predicting acute cholecystitis on final pathology to prioritize surgical urgency: an evaluation of the Tokyo criteria and development of a novel predictive score
Canadian Journal of Surgery, suppl 6 Suppl 2 ; 65, 2022.
Article in English | ProQuest Central | ID: covidwho-2263154
ABSTRACT

Background:

The COVID-19 pandemic has compounded limitations in access to the operating room, highlighting the need for improved surgical prioritization rules for common pathologies, including acute cholecystitis. The objective of this study was to compare the performance of our institution's surgical prioritization rules to the Tokyo diagnostic criteria and to develop a novel decision rule to predict acute cholecystitis on surgical pathology.

Methods:

All consecutive adult patients undergoing emergency cholecystectomy at a single academic institution between April 2017 and April 2021 were reviewed. The primary outcome was diagnosis of acute inflammation on final pathologic analysis. Multiple logistic regression was performed with a training subset using relevant clinical variables that were selected a priori. A simple weighted decision rule was created and compared with the Tokyo diagnostic criteria and the institution's existing prioritization rules via an analysis of receiver operating characteristic curves on a second subset of the population.

Results:

Among 756 patients undergoing emergency cholecystectomy, 97.6% met criteria for acute cholecystitis as per Tokyo diagnostic criteria. Tokyo criteria (area under the curve [AUC] 0.51, sensitivity 99%, specificity 3%) poorly discriminated for acute inflammation on final pathology. Discrimination of the hospital's case prioritization rules was moderate (AUC 0.63, sensitivity 48%, specificity 78%), and a new simple decision rule incorporating fever, Murphy sign, leukocytosis and inflammation on imaging was significantly higher (AUC 0.69, sensitivity 72%, specificity 64%, p < 0.003).

Conclusion:

In this large cohort of emergency cholecystectomies, the Tokyo diagnostic criteria were highly sensitive but nonspecific for acute cholecystitis on final pathology. An existing institutional case prioritization rule showed moderate discrimination for these outcomes but was outperformed by a novel parsimonious score incorporating readily available preoperative variables. These findings may be useful in the prioritization of emergency cholecystectomies at busy centres but remain to be validated in outside cohorts.
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Collection: Databases of international organizations Database: ProQuest Central Type of study: Experimental Studies / Prognostic study Language: English Journal: Canadian Journal of Surgery, suppl 6 Suppl 2 Year: 2022 Document Type: Article

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Collection: Databases of international organizations Database: ProQuest Central Type of study: Experimental Studies / Prognostic study Language: English Journal: Canadian Journal of Surgery, suppl 6 Suppl 2 Year: 2022 Document Type: Article