DOCENTE:VICKY JEANNINE PANDURO CORREA

Prediction of morbidity and mortality after

early cholecystectomy for acute calculous
cholecystitis: results of the S.P.Ri.M.A.C.C.
study

INTEGRANTES:
CONDORI SOTELO, LUIS FERNANDO
CONTRERAS DE LA CRUZ, HECTOR FABIAN

Te prevalence of gallstones in the
general population is 10–15%, and
20–40% of these patients will
likely develop gallstone-related
complications.
Te most used guidelines for
managing ACC are the Tokyo
guidelines (TG) [2–4] and the
World Society of Emergency
Surgery (WSES) guidelines (GL) [1,
5]. TG and WSES GL agree to
identify early cholecystectomy (EC)
as the frst-line therapy for ACC.
ANTECEDENTES
In 2021, Di Martino et al. created
a relatively simple and easily
reproducible score to select patients
with a higher risk of complicated
course after EC for ACC. Te
model was validated by an internal
retrospective analysis.
1
Recently, some other well-known risk
prediction models (POSSUM), modifed
Frailty Index (mFI), CCI have been
applied and validated for EC in
patients with ACC, but almost all are
missing a formal perspective or
external validation
. Acute calculous cholecystitis
(ACC) represents the frst clinical
presentation in 10–15% of patients
with gallstone-related complications.
 Metodos
Ethical considerations
Te study protocol was approved by the
medical Ethics Board of the trial
coordinating center at the IRCCS San
Matteo Hospital, Pavia. Secondary
approvals were obtained from all local
ethics committees in the participating
centers. Patients gave orally and written
informed consent prior to inclusion. Te
SPRIMACC trial was conducted in
accordance with the declaration of Helsinki.
Design
Te S.P.Ri.M.A.C.C. study is a WSES prospective
multicenter observational study. From 1st
September 2021 to 1st September 2022, 1,253
patients from 79 centers located in 19 diferent
countries were included in the study. It was
registered in ClicalTrial.gov with the following
identifer: NCT04995380 and adhered to
TRIPOD guidelines/methodology.
 Metodos

The Chole‑risk score Study variables

Te Chole-risk Score was developed using four groups of Te primary endpoint of S.P.Ri.M.A.C.C. study
preoperative variables: (a) previous abdominal surgery or was the composite outcome already used in the
previous percutaneous cholecystostomy; (b)
work by Di Martino et al., including 30-day
patientcomorbidities such as diabetes and CCI>6; (c)
postoperative major morbidity (intended as
≥
predictors of concomitant bile duct stones such as increased
total bilirubin>2 mg/dL and dilated bile duct; (d) predictors of Clavien-Dindo 3a complications), length of stay
difcult cholecystectomy such as perforated gallbladder and (LOS)>10 days and readmission within 30 days
severity grade from the discharge.
Each group can score either 0 or 1 for a positive variable. Te
score with its risk assessment was made available online at
https://www.calconic.com/calculator-widgets/
cholerisk/5f00380606e42a00296f59de?layouts=true.
 Metodos

Inclusion and exclusion criteria

Inclusion criteria were have a diagnosis of ACC as defned by 2018 TG criteria, be a candidate for EC during
≥
the index admission be 18 years old, be stratifed for the risk of common bile duct stones, and, in case of
confrmation, receive preoperative ERCP, provide a signed and dated informed consent form and be willing to
comply with all study procedures and be available for the duration of the study

Exclusion criteria were pregnancy or lactation, acute cholecystitis not related to a gallstone etiology, onset of
symptoms>10 days before cholecystectomy concomitant cholangitis or pancreatitis, intraoperative treatment
of common bile duct stones, or anything that would increase the risk for the patient or preclude the
individual’s full compliance with or completion of the study
 Metodos

Inclusion and exclusion criteria

Inclusion criteria were have a diagnosis of ACC as defned by 2018 TG criteria, be a candidate for EC during
≥
the index admission be 18 years old, be stratifed for the risk of common bile duct stones, and, in case of
confrmation, receive preoperative ERCP, provide a signed and dated informed consent form and be willing to
comply with all study procedures and be available for the duration of the study

Exclusion criteria were pregnancy or lactation, acute cholecystitis not related to a gallstone etiology, onset of
symptoms>10 days before cholecystectomy concomitant cholangitis or pancreatitis, intraoperative treatment
of common bile duct stones, or anything that would increase the risk for the patient or preclude the
individual’s full compliance with or completion of the study
 Result and Discussion
A total of 1429 consecutive
patients were enrolled from 1st The patients’ preoperative characteristics
September 2021 to 1st September and scores are shown in Table
2022.
A 30-day major morbidity of 6.6% and 30-
day mortality of 1.1% were found

POSSUM PS was the best risk prediction

model for a complicated course after EC for
ACC

Conclusión
Gracias