Risk factors for acute gangrenous cholecystitis in emergency general surgery patients

• Acute gangrenous cholecystitis is a medical emergency that carries a high rate of morbidity and mortality.
• The objective of this study is to define risk factors for the detection of this disease.
• In this retrospective review, mortality was 12.5% with acute gangrenous cholecystitis compared with a negligible mortality in patients without necrosis.
• In this single center study, comorbidities such as diabetes mellitus and coronary artery disease were associated with a higher incidence of acute gangrenous cholecystitis.
• Patients with acute gangrenous cholecystitis were more commonly older and of male sex, as well as more likely to trigger the SIRS/sepsis alert in the computerized medical record system.

BackgroundAcute gangrenous cholecystitis (AGC) is a medical emergency that carries high morbidity. The objective of this study is to define risk factors for this disease.MethodsA retrospective review of patients who underwent cholecystectomy while admitted to the Acute Care Surgery Service from January 2009 to April 2014 was performed. Specimen reports were evaluated to identify patients with AGC and cholecystitis without necrosis (CN). Preoperative factors as well as outcomes were compared between the groups.ResultsA total of 483 patents underwent cholecystectomy. Four hundred fifty-nine patients were found to have CN and 24 patients were found to have AGC. Pre-existent factors such as diabetes, coronary artery disease, and systemic inflammatory response syndrome predicted AGC on a logistic regression. Patients with AGS were also more commonly older, male, and had a higher preoperative bilirubin. Mortality was significantly higher in patients with AGC (12.5% vs .9%, P = .003).ConclusionsAGC carries an increased mortality rate compared with CN. Older patients with diabetes, coronary artery disease, and elevated bilirubin should be suspected of having AGC.