Digestive and General Surgery Department, 12 de Octubre University Hospital, Madrid, Spain.
Digestive and General Surgery Department, Ramón y Cajal University Hospital, Madrid, Spain.
Eur J Trauma Emerg Surg. 2021 Jun;47(3):683-692. doi: 10.1007/s00068-021-01631-1. Epub 2021 Mar 19.
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.
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.
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.
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.
分析第一次大流行爆发后外科协会建议的急性胆囊炎（AC）管理情况，估计发病率、住院时间、死亡率和医院获得性 SARS-CoV-2 感染率。
马德里社区 2020 年 3 月 1 日至 5 月 30 日期间的多中心合并（回顾性-前瞻性）队列研究，共涉及 16 家公立医院的 257 例 AC 患者。应用多变量二项逻辑回归（MBLR）分析死亡率。
COVID-19 患者中，30 例在入院时确诊，12 例在入院期间或出院后 30 天内确诊。在非 COVID-19 患者中，61.3%的 I 级 AC 和 40.6%的 II 级 AC 接受了抗生素治疗。52.4%的 III 级 AC 接受了经皮引流（PD）治疗。中位住院时间为 5[3-8]天，非手术治疗组为 7.51 天（p<0.001），死亡率为 3.25%（p<0.21），住院时间更长。入院时患有 SARS-CoV-2 感染的 93.3%患者接受了非手术治疗（p=0.03），中位住院时间为 11.0[7.5-27.5]天（p<0.001），死亡率为 7.5%（p>0.05）。在医院获得性 SARS-CoV-2 感染患者中，91.7%的 I-II 级 AC 接受了非手术治疗（p=0.037），中位住院时间为 16[4-21]天，死亡率为 18.2%（p>0.05）。住院时间超过 7 天的医院获得性感染风险为 OR 4.7，95%CI（1.3-16.6），p=0.009。COVID-19 死亡率为 11.9%，AC 严重程度调整后 OR 5.64（95%CI 1.417-22.64）。在 MBLR 分析中，年龄（OR 1.15，95%CI 1.02-1.31）、SARS-CoV-2 感染（OR 14.49，95%CI 1.33-157.81）、保守治疗失败（OR 8.2，95%CI 1.34-50.49）和 AC 严重程度与死亡率增加相关。
在我们的人群中，在 COVID-19 大流行期间，非手术治疗的比例增加，随之而来的是保守治疗失败、发病率和住院时间延长，这可能导致医院获得性 SARS-CoV-2 感染的风险增加。年龄、SARS-CoV-2 感染、AC 严重程度和保守治疗失败是死亡的危险因素。
