Expanded analysis for patients with acute cholecystitis indicates outcomes vary based on COVID-19 status and treatment modality

Abstract

BackgroundThe impact of different phases of COVID-19 infection on outcomes from acute calculous cholecystitis is not well understood. Therefore, we examined outcomes of acute cholecystitis during the COVID-19 pandemic, comparing the effect of different treatment modalities as well as COVID-19 infection status. We hypothesized that acute COVID-19 patients would have worse outcomes than COVID-negative patients, but there would be no difference between COVID-negative and COVID-recovered patients. MethodsWe utilized 2020-2023 National COVID Cohort Collaborative data to identify adults with acute calculous cholecystitis. Treatment (antibiotics-only, cholecystostomy tube, or cholecystectomy), and COVID-19 status (negative, active, or recovered) were collected. Treatment failure of non-operative managements was noted. Adjusted analysis using a series of generalized linear models controlled for confounders (age, sex, BMI, Charlson comorbidity index, severity at presentation, and year) to better assess differences in outcomes between treatment groups, as well as between COVID-19 groups. ResultsIn total, 32,433¥ patients were included: 29,749 COVID-negative, 2,112 COVID-active, and 572¥ COVID-recovered. COVID-active had higher rates of sepsis at presentation. COVID-negative more often underwent cholecystectomy. Unadjusted, COVID-active had higher 30-day mortality, 30-day complication, and longer LOS than COVID-negative and COVID-recovered. Adjusted analysis revealed cholecystectomy carried lower odds of mortality for COVID-active and COVID-negative patients, compared with antibiotics or cholecystostomy. COVID-recovered patients’ mortality was unaffected by treatment modality. Treatment failure from antibiotics was more common for COVID-negative patients. ConclusionsAcute cholecystitis outcomes are impacted by phase of COVID-19 infection and treatment modality. Cholecystectomy does not lead to worse outcomes for COVID-active and COVID-recovered patients, compared with non-operative treatments, thus these patients can be considered for cholecystectomy if their physiology is not prohibitive.