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Factors associated with the Lack of Response to Conservative Management in Patients with Acute Cholecystitis over 72 Hours of Evolution

Author(s): Diego Rivas Arana, Sebastián De la Puente, Fredy Canchihuaman Rivera, César Loza Munarriz, Yahaira Carpio Colmenares, Giuliano Borda-Luque

Introduction: Acute lithiasic cholecystitis is one of the most common gallbladder pathologies. Conservative treatment can hardly be considered as a definitive treatment. The objective of this study is to determine the factors associated with the lack of response of such management in patients with acute cholecystitis with more than 72 hours of disease evolution.

Material and methods: An observational, analytical and retrospective case-control study was carried out at the Cayetano Heredia National Hospital. The cases were patients who needed emergency surgery after the start of conservative treatment; and the controls those who had a good response to this treatment. The factors associated with the failure of conservative management were analyzed; and then, through a logistic regression analysis, identify the best predictive model for this poor response was identified.

Results: A total of 136 patients were included, being the cases 44. The factors that had a greater degree of association with the lack of response to conservative management were advanced age (OR=2.34 CI=1.05-5.28), thickened gallbladder wall (OR=7.38 CI=3.22-16.96), gallbladder distention (OR=6.38 CI=2.56-15.92), persistent fever (OR=3.55 CI=1.57-8.04), leukocytosis at admission (OR=2.20, CI=1.04-4.64) and at 48 hours (OR=2.73 CI=1.26-5.94), tachycardia at admission (OR=3.11 CI=1.29-7.48) and obesity (OR=2.45 CI=1.08-5.60). A predictive model was developed, which predicts 96.78% failure to conservative management.

Conclusions: There are several factors associated with the failure in the conservative management of acute cholecystitis with more than 72 hours of disease evolution. Considering these factors might allow early identification of patients who have a high probability of failure to such treatment.

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