ABSTRACT
PURPOSE: To analyse acute cholecystitis (AC) management during the first pandemic outbreak after the recommendations given by the surgical societies estimating: morbidity, length of hospital stay, mortality and hospital-acquired SARS-CoV-2 infection rate. METHODS: Multicentre-combined (retrospective-prospective) cohort study with AC patients in the Community of Madrid between 1st March and 30th May 2020. 257 AC patients were involved in 16 public hospital. Multivariant binomial logistic regression (MBLR) was applied to mortality. RESULTS: Of COVID-19 patients, 30 were diagnosed at admission and 12 patients were diagnosed during de admission or 30 days after discharge. In non-COVID-19 patients, antibiotic therapy was received in 61.3% of grade I AC and 40.6% of grade II AC. 52.4% of grade III AC were treated with percutaneous drainage (PD). Median hospital stay was 5 [3-8] days, which was higher in the non-surgical treatment group with 7.51 days (p < 0.001) and a 3.25% of mortality rate (p < 0.21). 93.3% of patients with SARS-CoV-2 infection at admission were treated with non-surgical treatment (p = 0.03), median hospital stay was 11.0 [7.5-27.5] days (p < 0.001) with a 7.5% of mortality rate (p > 0.05). In patients with hospital-acquired SARS-CoV-2 infection, 91.7% of grade I-II AC were treated with non-surgical treatment (p = 0.037), with a median hospital stay of 16 [4-21] days and a 18.2% mortality rate (p > 0.05). Hospital-acquired infection risk when hospital stay is > 7 days is OR 4.7, CI 95% (1.3-16.6), p = 0.009. COVID-19 mortality rate was 11.9%, AC severity adjusted OR 5.64 (CI 95% 1.417-22.64). In MBLR analysis, age (OR 1.15, CI 95% 1.02-1.31), SARS-CoV-2 infection (OR 14.49, CI 95% 1.33-157.81), conservative treatment failure (OR 8.2, CI 95% 1.34-50.49) and AC severity were associated with an increased odd of mortality. CONCLUSION: In our population, during COVID-19 pandemic, there was an increase of non-surgical treatment which was accompanied by an increase of conservative treatment failure, morbidity and hospital stay length which may have led to an increased risk hospital-acquired SARS-CoV-2 infection. Age, SARS-CoV-2 infection, AC severity and conservative treatment failure were mortality risk factors.
Subject(s)
Anti-Bacterial Agents/therapeutic use , COVID-19 , Cholecystectomy/statistics & numerical data , Cholecystitis, Acute , Conservative Treatment , Cross Infection , Infection Control , COVID-19/diagnosis , COVID-19/mortality , COVID-19/prevention & control , Cholecystitis, Acute/diagnosis , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/therapy , Cohort Studies , Comorbidity , Conservative Treatment/methods , Conservative Treatment/statistics & numerical data , Cross Infection/epidemiology , Cross Infection/virology , Drainage/methods , Drainage/statistics & numerical data , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Infection Control/standards , Length of Stay/statistics & numerical data , Male , Middle Aged , Outcome and Process Assessment, Health Care , Risk Assessment , SARS-CoV-2 , Spain/epidemiologyABSTRACT
Presentamos el caso de una mujer de 45 años diagnosticada incidentalmente de lesión quística pancreática compatible con cistoadenoma seroso de 14 mm. Tras cinco años de seguimiento (TAC y RM) la lesión triplicó su tamaño y se indicó la intervención. Teniendo en cuenta la probable benignidad de la lesión, y en un intento de preservar tanto el bazo como la mayor cantidad posible de parénquima pancreático, se realizó una pancreatectomía central con derivación del remanente distal. Se revisa la literatura nacional e internacional publicada (AU)
We present the case of a 45 year old female patient with an incidental diagnosis of a cystic pancreatic lesion corresponding to a serous cystadenoma of 14 mm. During a 5-year follow-up (CT and MRT) the lesion tripled in size and a surgical intervention was decided upon. The lesion was thought to have a benign pathology and, in an attempt to preserve the spleen and a major portion of pancreatic tissue, a central pancreatectomy with a diversion of the remaining distal pancreas was carried out. The authors reviewed national and international publications (AU)
Subject(s)
Humans , Female , Adult , Pancreatectomy/instrumentation , Pancreatectomy/methods , Pancreas/injuries , Pancreas/pathology , Pancreas , Pancreatic Diseases/complications , Pancreatic Diseases , Laparotomy/methods , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy/methods , Anastomosis, Surgical , Fistula/surgeryABSTRACT
We present the case of a 45 year old female patient with an incidental diagnosis of a cystic pancreatic lesion corresponding to a serous cystadenoma of 14 mm. During a 5-year follow-up (CT and MRT) the lesion tripled in size and a surgical intervention was decided upon. The lesion was thought to have a benign pathology and, in an attempt to preserve the spleen and a major portion of pancreatic tissue, a central pancreatectomy with a diversion of the remaining distal pancreas was carried out. The authors reviewed national and international publications.