Akademik Veri Yönetim Sistemi
WORLD JOURNAL OF EMERGENCY SURGERY, cilt.18, ss.20, 2023 (SCI-Expanded)
Abstract Background Less invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treat‑ ment have been spreading in recent years. We still lack a reliable tool to select highrisk patients who could beneft from these alternatives. Our study aimed to prospectively validate the Cholerisk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models. Method The S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A CochranArmitage test of the trend was run to determine whether a linear correlation existed between the Cholerisk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models—POSSUM Physiological Score (PS), modifed Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade—receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities. Results A 30day major morbidity of 6.6% and 30day mortality of 1.1% were found. Cholerisk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (inhospital mortality: AUC 0.94, p<0.001; 30day mortality: AUC 0.94, p<0.001; inhospital major morbidity: AUC 0.73, p<0.001; 30day major morbidity: AUC 0.70, p<0.001). POSSUM PS with a cutof of 25 (defned in our study as a ‘CholePOSSUM’ score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96–97% negative predictive value for major complications. Conclusions The Cholerisk score was externally validated, but the CHOLEPOSSUM stands as a more accurate pre‑ diction model. CHOLEPOSSUM is a reliable tool to stratify patients with ACC into a lowrisk group that may represent