The ChoCO.W prospective observational global study: Does COVID.19 increase gangrenous cholecystitis?
De Simone, Belinda;Abu zidan, Fikri M.;Chouillard, Elie;Di Saverio, Salomone;Sartelli, Massimo;Podda, Mauro;Augusto Gomes, Carlos;Moore, Ernest E.;Moug, Susan J.;Ansaloni, Luca;Kluger, Yoram;Coccolini, Federico;Landaluce olavarria, Aitor;Estraviz mateos, Begoña;Uriguen etxeberria, Ana;Giordano, Alessio;Palmieri Luna, Alfonso;Adriana Hernández Amín, Luz;María Palmieri Hernández, Adriana;Shabana, Amanda;Andee Dzulkarnaen, Zakaria;Asyraf Othman, Muhammad;Ikhwan Sani, Mohamad;Balla, Andrea;Scaramuzzo, Rosa;Lepiane, Pasquale;Bottari, Andrea;Staderini, Fabio;Cianchi, Fabio;Cavallaro, Andrea;Zanghì, Antonio;Cappellani, Alessandro;Campagnacci, Roberto;Maurizi, Angela;Martinotti, Mario;Ruggieri, Annamaria;Che Jusoh, Asri;Abdul Rahman, Karim;Zulkifli, Anis Suraya M.;Petronio, Barbara;Matías garcía, Belén;Quiroga valcárcel, Ana;Mendoza moreno, Fernando;Atanasov, Boyko;Cesare Campanile, Fabio;Vecchioni, Ilaria;Cardinali, Luca;Travaglini, Grazia;Sebastiani, Elisa;Chooklin, Serge;Chuklin, Serhii;Cianci, Pasquale;Restini, Enrico;Capuzzolo, Sabino;Currò, Giuseppe;Filippo, Rosalinda;Rispoli, Michele;Aparicio sánchez, Daniel;Durán Muñóz Cruzado, Virginia;Dios Barbeito, Sandra;Delibegovic, Samir;Kesetovic, Amar;Sasia, Diego;Borghi, Felice;Giraudo, Giorgio;Visconti, Diego;Doria, Emanuele;Santarelli, Mauro;Luppi, Davide;Bonilauri, Stefano;Grossi, Ugo;Zanus, Giacomo;Sartori, Alberto;Piatto, Giacomo;De Luca, Maurizio;Vita, Domenico;Conti, Luigi;Capelli, Patrizio;Maria Cattaneo, Gaetano;Marinis, Athanasios;Vederaki, Styliani aikaterini;Bayrak, Mehmet;Altıntas, Yasemin;Yener Uzunoglu, Mustafa;Eren Demirbas, Iskender;Altinel, Yuksel;Meric, Serhat;Emre Aktimur, Yunus;Salim Uymaz, Derya;Omarov, Nail;Azamat, Ibrahim;Lostoridis, Eftychios;Nagorni, Eleni aikaterini;Pujante, Antonio;Anania, Gabriele;Bombardini, Cristina;Bagolini, Francesco;Gonullu, Emre;Mantoglu, Baris;Capoglu, Recayi;Cappato, Stefano;Muzio, Elena;Colak, Elif;Polat, Suleyman;Alan Koylu, Zehra;Altintoprak, Fatih;Bayhan, Zülfü;Akin, Emrah;Andolfi, Enrico;Rezart, Sulce;Il Kim, Jae;Won Jung, Sung;Chan Shin, Yong;Enciu, Octavian;Adelina Toma, Elena;Medas, Fabio;Canu, GIAN LUIGI;Cappellacc, Federico;D’Acapito, Fabrizio;Ercolani, Giorgio;Solaini, Leonardo;Roscio, Francesco;Clerici, Federico;Gelmini, Roberta;Serra, Francesco;Giulia Rossi, Elena;Fleres, Francesco;Clarizia, Guglielmo;Spolini, Alessandro;Ferrara, Francesco;Nita, Gabriela;Sarnari, Jlenia;Gachabayov, Mahir;Abdullaev, Abakar;Poillucci, Gaetano;Marco Palini, Gian;Veneroni, Simone;Garulli, Gianluca;Piccoli, Micaela;Casoni Pattacini, Gianmaria;Pecchini, Francesca;Argenio, Giulio;Fortunato Armellino, Mariano;Brisinda, Giuseppe;Tedesco, Silvia;Fransvea, Pietro;Ietto, Giuseppe;Franchi, Caterina;Carcano, Giulio;Martines, Gennaro;Trigiante, Giuseppe;Negro, Giulia;Machain Vega, Gustavo;Rodríguez González, Agustín;Ojeda, Leonardo;Piccolo, Gaetano;Bondurri, Andrea;Maffioli, Anna;Guerci, Claudio;Han Sin, Boo;Zuhdi, Zamri;Azman, Azlanudin;Mousa, Hussam;al Bahri, Shadi;Augustin, Goran;Romic, Ivan;Moric, Trpimir;Nikolopoulos, Ioannis;Andreuccetti, Jacopo;Pignata, Giusto;D’Alessio, Rossella;Kenig, Jakub;Skorus, Urszula;Pereira Fraga, Gustavo;Shiyoiti Hirano, Elcio;Vinícius de Lima Bertuol, Jackson;Isik, Arda;Kurnaz, Eray;Sohail Asghar, Mohammad;Afzal, Ameer;Akbar, Ali;Konstantinos Nikolouzakis, Taxiarchis;Lasithiotakis, Konstantinos;Chrysos, Emmanuel;Das, Koray;Özer, Nazmi;Seker, Ahmet;Ibrahim, Mohamed;Hamid, Hytham K. S.;Babiker, Ahmed;Bouliaris, Konstantinos;Koukoulis, George;Kolla, Chrysoula christina;Lucchi, Andrea;Agostinelli, Laura;Taddei, Antonio;Fortuna, Laura;Agostini, Carlotta;Licari, Leo;Viola, Simona;Callari, Cosimo;Laface, Letizia;Abate, Emmanuele;Casati, Massimiliano;Anastasi, Alessandro;Canonico, Giuseppe;Gabellini, Linda;Tosi, Lorenzo;Guariniello, Anna;Zanzi, Federico;Bains, Lovenish;Sydorchuk, Larysa;Iftoda, Oksana;Sydorchuk, Andrii;Malerba, Michele;Costanzo, Federico;Galleano, Raffaele;Monteleone, Michela;Costanzi, Andrea;Riva, Carlo;Walędziak, Maciej;Kwiatkowski, Andrzej;Czyżykowski, Łukasz;Major, Piotr;Strzałka, Marcin;Matyja, Maciej;Natkaniec, Michal;Rosaria Valenti, Maria;Domenica Pia Di Vita, Maria;Sotiropoulou, Maria;Kapiris, Stylianos;Massalou, Damien;Veroux, Massimiliano;Volpicelli, Alessio;Gioco, Rossella;Uccelli, Matteo;Bonaldi, Marta;Olmi, Stefano;Nardi, Matteo;Livadoti, Giada;Mesina, Cristian;Viorel Dumitrescu, Theodor;Calin Ciorbagiu, Mihai;Ammendola, Michele;Ammerata, Giorgio;Romano, Roberto;Slavchev, Mihail;Misiakos, Evangelos P.;Pikoulis, Emmanouil;Papaconstantinou, Dimitrios;Elbahnasawy, Mohamed;Abdel elsalam, Sherief;Felsenreich, Daniel M.;Jedamzik, Julia;Michalopoulos, Nikolaos V.;Sidiropoulos, Theodoros A.;Papadoliopoulou, Maria;Cillara, Nicola;Deserra, Antonello;Cannavera, Alessandro;Negoi, Ionuţ;Schizas, Dimitrios;Syllaios, Athanasios;Vagios, Ilias;Gourgiotis, Stavros;Dai, Nick;Gurung, Rekha;Norrey, Marcus;Pesce, Antonio;Vittorio Feo, Carlo;Fabbri, Nicolo’;Machairas, Nikolaos;Dorovinis, Panagiotis;Keramida, Myrto D.;Mulita, Francesk;Ioannis Verras, Georgios;Vailas, Michail;Yalkin, Omer;Iflazoglu, Nidal;Yigit, Direnc;Baraket, Oussama;Ayed, Karim;hedi Ghalloussi, Mohamed;Patias, Parmenion;Ntokos, Georgios;Rahim, Razrim;Bala, Miklosh;Kedar, Asaf;Sawyer, Robert G.;Trinh, Anna;Miller, Kelsey;Sydorchuk, Ruslan;Knut, Ruslan;Plehutsa, Oleksandr;Kevser Liman, Rumeysa;Ozkan, Zeynep;Abdel Kader, Saleh;Gupta, Sanjay;Gureh, Monika;Saeidi, Sara;Aliakbarian, Mohsen;Dalili, Amin;Shoko, Tomohisa;Kojima, Mitsuaki;Nakamoto, Raira;Demirli Atici, Semra;Kilinc Tuncer, Gizem;Kaya, Tayfun;Delis, Spiros G.;Rossi, Stefano;Picardi, Biagio;Rossi del Monte, Simone;Triantafyllou, Tania;Theodorou, Dimitrios;Pintar, Tadeja;Salobir, Jure;Manatakis, Dimitrios K.;Tasis, Nikolaos;Acheimastos, Vasileios;Ioannidis, Orestis;Loutzidou, Lydia;Symeonidis, Savvas;Correia de Sá, Tiago;Rocha, Mónica;Guagni, Tommaso;Pantalone, Desiré;Maltinti, Gherardo;Khokha, Vladimir;Abdel elsalam, Wafaa;Ghoneim, Basma;Antonio López Ruiz, José;Kara, Yasin;Zainudin, Syaza;Hayati, Firdaus;Azizan, Nornazirah;Tan Phooi Khei, Victoria;Choy Xin Yi, Rebecca;Sellappan, Harivinthan;Demetrashvili, Zaza;Lekiashvili, Nika;Tvaladze, Ana;Froiio, Caterina;Bernardi, Daniele;Bonavina, Luigi;Gil olarte, Angeles;Grassia, Sebastiano;Romero vargas, Estela;Bianco, Francesco;Gumbs, Andrew A.;Dogjani, Agron;Agresta, Ferdinando;Litvin, Andrey;Balogh, Zsolt J.;Gendrikson, George;Martino, Costanza;Damaskos, Dimitrios;Pararas, Nikolaos;Kirkpatrick, Andrew;Kurtenkov, Mikhail;Couto Gomes, Felipe;Pisanu, Adolfo;Nardello, Oreste;Gambarini, Fabrizio;Aref, Hager;de’ Angelis, Nicola;Agnoletti, Vanni;Biondi, Antonio;Vacante, Marco;Griggio, Giulia;Tutino, Roberta;Massani, Marco;Bisetto, Giovanni;Occhionorelli, Savino;Andreotti, Dario;Lacavalla, Domenico;Biffl, Walter L.;Catena, Fausto
2022-01-01
Abstract
Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month followup. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID- 19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.