Gangrenous cholecystitis represents over a third of emergency cholecystectomies in a tertiary Australian hospital

Abstract

Introduction: Gangrenous cholecystitis(GC) is reported to occur in 10-40% of acute cholecystitis. The current literature reports a higher rate of conversion to open surgery, bile duct injury, morbidity, and mortality with GC. Methods: A retrospective review of emergency cholecystectomies over a three-year period at The Prince Charles Hospital in Brisbane. Results: A total of 152 emergency cholecystectomies were performed during the study period. 57 (37.5%) were gangrenous and 95 (62.5%) were non-gangrenous cholecystitis(NGC). Patients with GC were older (mean age 59.1 vs 49.6, p< = 0.002), and more likely to be male (56.1% vs 33.7%, p = 0.011). Patients with GC had thicker gallbladder wall on ultrasound(0.583 cm vs 0.464 cm), higher white cell count (16.84 x 109/L vs 8.2 x 109/L, p=0.0001), and higher C-reactive protein(154 mg/L vs 59 mg/L. p = 0.0002). There was no difference in time from presentation to surgery (GC vs NGC 64.5 hours vs 73.5 hours, p = 0.49). Duration of surgery was longer for GC (120 vs 89 minutes, p < 0.0001). There was one death in the GC group and no conversions to open surgery or bile duct injuries. Post-operative length of hospital stay was longer for the GC group (Median of 3 days vs 1 day, p < 0.001). Conclusion: GC represents over a third of emergency cholecystectomies performed at our institution. Patients with GC are more likely to be male, older, have thicker gallbladder wall on ultrasound, higher white cell count, and C-reactive protein. Patients with GC had longer operative times and longer post-operative length of stay.