Evaluating the advantages of treating acute cholecystitis by following TG18

Abstract

Introduction: Acute cholecystitis is one of the most common diseases in patient with acute abdomen. Current management of acute cholecystitis is based on Tokyo guideline suggestion. In current studies, there's not much discussion about the cost and outcome for acute cholecystitis with different severity. In our study, we would like to analyze and discuss the cost-effectiveness and outcome for the treatment of acute cholecystitis based on TG18. Method: From October, 2015 to December, 2016, patients ≧18 years old with a diagnosis of acute cholecystitis in Linkou Chang Gung Memorial Hospital and those who were operated were included. Patient demographics, length of hospital stay, operation details, medical costs, morbidity and in-hospital mortality are recorded. Patients were divided into 3 groups according to their severity, and were further divided into two subgroups according their treatment modality (follow or deviate TG18). Result: In our study, ratio of follow or deviated from TG18 were listed. Grade I and grade II (should be operated early according to TG18) patients with higher age, higher CCI, higher CRP, tended to had a delayed operation. Compared to those who had a early operation, delayed operation had higher medical cost (follow/diviate, p<0.005) and longer length of total hospital stay (follow/deviated,p<0.001). In contrast, for those grade II and III patients that delayed operation were recommended, higher conversion rate, more blood loss, higher morbidity, and higher ICU admission were noted if these patients were treated against TG 18 recommendation. Conclusion: According to our study, TG18 treatment suggestion is cost-effective and has good clinical outcome.