The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

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<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. 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.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>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 (<jats:italic>p</jats:italic> < 0.0001), diabetes (<jats:italic>p</jats:italic> < 0.0001), and severe chronic obstructive airway disease (<jats:italic>p</jats:italic> = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (<jats:italic>p</jats:italic> < 0.0001), PIPAS score (<jats:italic>p</jats:italic> < 0.0001), WSES sepsis score (<jats:italic>p</jats:italic> < 0.0001), qSOFA (<jats:italic>p</jats:italic> < 0.0001), and Tokyo classification of severity of acute cholecystitis (<jats:italic>p</jats:italic> < 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%, <jats:italic>p</jats:italic> < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, <jats:italic>p</jats:italic> < 0.0001), and mortality rate (13.4% compared with 1.7%, <jats:italic>p</jats:italic> < 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; <jats:italic>p</jats:italic> < 0.0001].</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Graphical abstract</jats:title> </jats:sec>

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