World Journal of Emergency Surgery (Dec 2022)

The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

  • Belinda De Simone,
  • Fikri M. Abu-Zidan,
  • Elie Chouillard,
  • Salomone Di Saverio,
  • Massimo Sartelli,
  • Mauro Podda,
  • Carlos Augusto Gomes,
  • Ernest E. Moore,
  • Susan J. Moug,
  • Luca Ansaloni,
  • Yoram Kluger,
  • Federico Coccolini,
  • Aitor Landaluce-Olavarria,
  • Begoña Estraviz-Mateos,
  • Ana Uriguen-Etxeberria,
  • Alessio Giordano,
  • Alfonso Palmieri Luna,
  • Luz Adriana Hernández Amín,
  • Adriana María Palmieri Hernández,
  • Amanda Shabana,
  • Zakaria Andee Dzulkarnaen,
  • Muhammad Asyraf Othman,
  • Mohamad Ikhwan Sani,
  • Andrea Balla,
  • Rosa Scaramuzzo,
  • Pasquale Lepiane,
  • Andrea Bottari,
  • Fabio Staderini,
  • Fabio Cianchi,
  • Andrea Cavallaro,
  • Antonio Zanghì,
  • Alessandro Cappellani,
  • Roberto Campagnacci,
  • Angela Maurizi,
  • Mario Martinotti,
  • Annamaria Ruggieri,
  • Asri Che Jusoh,
  • Karim Abdul Rahman,
  • Anis Suraya M. Zulkifli,
  • Barbara Petronio,
  • Belén Matías-García,
  • Ana Quiroga-Valcárcel,
  • Fernando Mendoza-Moreno,
  • Boyko Atanasov,
  • Fabio Cesare Campanile,
  • Ilaria Vecchioni,
  • Luca Cardinali,
  • Grazia Travaglini,
  • Elisa Sebastiani,
  • Serge Chooklin,
  • Serhii Chuklin,
  • Pasquale Cianci,
  • Enrico Restini,
  • Sabino Capuzzolo,
  • Giuseppe Currò,
  • Rosalinda Filippo,
  • Michele Rispoli,
  • Daniel Aparicio-Sánchez,
  • Virginia Durán Muñóz-Cruzado,
  • Sandra Dios Barbeito,
  • Samir Delibegovic,
  • Amar Kesetovic,
  • Diego Sasia,
  • Felice Borghi,
  • Giorgio Giraudo,
  • Diego Visconti,
  • Emanuele Doria,
  • Mauro Santarelli,
  • Davide Luppi,
  • Stefano Bonilauri,
  • Ugo Grossi,
  • Giacomo Zanus,
  • Alberto Sartori,
  • Giacomo Piatto,
  • Maurizio De Luca,
  • Domenico Vita,
  • Luigi Conti,
  • Patrizio Capelli,
  • Gaetano Maria Cattaneo,
  • Athanasios Marinis,
  • Styliani-Aikaterini Vederaki,
  • Mehmet Bayrak,
  • Yasemin Altıntas,
  • Mustafa Yener Uzunoglu,
  • Iskender Eren Demirbas,
  • Yuksel Altinel,
  • Serhat Meric,
  • Yunus Emre Aktimur,
  • Derya Salim Uymaz,
  • Nail Omarov,
  • Ibrahim Azamat,
  • Eftychios Lostoridis,
  • Eleni-Aikaterini Nagorni,
  • Antonio Pujante,
  • Gabriele Anania,
  • Cristina Bombardini,
  • Francesco Bagolini,
  • Emre Gonullu,
  • Baris Mantoglu,
  • Recayi Capoglu,
  • Stefano Cappato,
  • Elena Muzio,
  • Elif Colak,
  • Suleyman Polat,
  • Zehra Alan Koylu,
  • Fatih Altintoprak,
  • Zülfü Bayhan,
  • Emrah Akin,
  • Enrico Andolfi,
  • Sulce Rezart,
  • Jae Il Kim,
  • Sung Won Jung,
  • Yong Chan Shin,
  • Octavian Enciu,
  • Elena Adelina Toma,
  • Fabio Medas,
  • Gian Luigi Canu,
  • Federico Cappellacci,
  • Fabrizio D’Acapito,
  • Giorgio Ercolani,
  • Leonardo Solaini,
  • Francesco Roscio,
  • Federico Clerici,
  • Roberta Gelmini,
  • Francesco Serra,
  • Elena Giulia Rossi,
  • Francesco Fleres,
  • Guglielmo Clarizia,
  • Alessandro Spolini,
  • Francesco Ferrara,
  • Gabriela Nita,
  • Jlenia Sarnari,
  • Mahir Gachabayov,
  • Abakar Abdullaev,
  • Gaetano Poillucci,
  • Gian Marco Palini,
  • Simone Veneroni,
  • Gianluca Garulli,
  • Micaela Piccoli,
  • Gianmaria Casoni Pattacini,
  • Francesca Pecchini,
  • Giulio Argenio,
  • Mariano Fortunato Armellino,
  • Giuseppe Brisinda,
  • Silvia Tedesco,
  • Pietro Fransvea,
  • Giuseppe Ietto,
  • Caterina Franchi,
  • Giulio Carcano,
  • Gennaro Martines,
  • Giuseppe Trigiante,
  • Giulia Negro,
  • Gustavo Machain Vega,
  • Agustín Rodríguez González,
  • Leonardo Ojeda,
  • Gaetano Piccolo,
  • Andrea Bondurri,
  • Anna Maffioli,
  • Claudio Guerci,
  • Boo Han Sin,
  • Zamri Zuhdi,
  • Azlanudin Azman,
  • Hussam Mousa,
  • Shadi al Bahri,
  • Goran Augustin,
  • Ivan Romic,
  • Trpimir Moric,
  • Ioannis Nikolopoulos,
  • Jacopo Andreuccetti,
  • Giusto Pignata,
  • Rossella D’Alessio,
  • Jakub Kenig,
  • Urszula Skorus,
  • Gustavo Pereira Fraga,
  • Elcio Shiyoiti Hirano,
  • Jackson Vinícius de Lima Bertuol,
  • Arda Isik,
  • Eray Kurnaz,
  • Mohammad Sohail Asghar,
  • Ameer Afzal,
  • Ali Akbar,
  • Taxiarchis Konstantinos Nikolouzakis,
  • Konstantinos Lasithiotakis,
  • Emmanuel Chrysos,
  • Koray Das,
  • Nazmi Özer,
  • Ahmet Seker,
  • Mohamed Ibrahim,
  • Hytham K. S. Hamid,
  • Ahmed Babiker,
  • Konstantinos Bouliaris,
  • George Koukoulis,
  • Chrysoula-Christina Kolla,
  • Andrea Lucchi,
  • Laura Agostinelli,
  • Antonio Taddei,
  • Laura Fortuna,
  • Carlotta Agostini,
  • Leo Licari,
  • Simona Viola,
  • Cosimo Callari,
  • Letizia Laface,
  • Emmanuele Abate,
  • Massimiliano Casati,
  • Alessandro Anastasi,
  • Giuseppe Canonico,
  • Linda Gabellini,
  • Lorenzo Tosi,
  • Anna Guariniello,
  • Federico Zanzi,
  • Lovenish Bains,
  • Larysa Sydorchuk,
  • Oksana Iftoda,
  • Andrii Sydorchuk,
  • Michele Malerba,
  • Federico Costanzo,
  • Raffaele Galleano,
  • Michela Monteleone,
  • Andrea Costanzi,
  • Carlo Riva,
  • Maciej Walędziak,
  • Andrzej Kwiatkowski,
  • Łukasz Czyżykowski,
  • Piotr Major,
  • Marcin Strzałka,
  • Maciej Matyja,
  • Michal Natkaniec,
  • Maria Rosaria Valenti,
  • Maria Domenica Pia Di Vita,
  • Maria Sotiropoulou,
  • Stylianos Kapiris,
  • Damien Massalou,
  • Massimiliano Veroux,
  • Alessio Volpicelli,
  • Rossella Gioco,
  • Matteo Uccelli,
  • Marta Bonaldi,
  • Stefano Olmi,
  • Matteo Nardi,
  • Giada Livadoti,
  • Cristian Mesina,
  • Theodor Viorel Dumitrescu,
  • Mihai Calin Ciorbagiu,
  • Michele Ammendola,
  • Giorgio Ammerata,
  • Roberto Romano,
  • Mihail Slavchev,
  • Evangelos P. Misiakos,
  • Emmanouil Pikoulis,
  • Dimitrios Papaconstantinou,
  • Mohamed Elbahnasawy,
  • Sherief Abdel-elsalam,
  • Daniel M. Felsenreich,
  • Julia Jedamzik,
  • Nikolaos V. Michalopoulos,
  • Theodoros A. Sidiropoulos,
  • Maria Papadoliopoulou,
  • Nicola Cillara,
  • Antonello Deserra,
  • Alessandro Cannavera,
  • Ionuţ Negoi,
  • Dimitrios Schizas,
  • Athanasios Syllaios,
  • Ilias Vagios,
  • Stavros Gourgiotis,
  • Nick Dai,
  • Rekha Gurung,
  • Marcus Norrey,
  • Antonio Pesce,
  • Carlo Vittorio Feo,
  • Nicolo’ Fabbri,
  • Nikolaos Machairas,
  • Panagiotis Dorovinis,
  • Myrto D. Keramida,
  • Francesk Mulita,
  • Georgios Ioannis Verras,
  • Michail Vailas,
  • Omer Yalkin,
  • Nidal Iflazoglu,
  • Direnc Yigit,
  • Oussama Baraket,
  • Karim Ayed,
  • Mohamed hedi Ghalloussi,
  • Parmenion Patias,
  • Georgios Ntokos,
  • Razrim Rahim,
  • Miklosh Bala,
  • Asaf Kedar,
  • Robert G. Sawyer,
  • Anna Trinh,
  • Kelsey Miller,
  • Ruslan Sydorchuk,
  • Ruslan Knut,
  • Oleksandr Plehutsa,
  • Rumeysa Kevser Liman,
  • Zeynep Ozkan,
  • Saleh Abdel Kader,
  • Sanjay Gupta,
  • Monika Gureh,
  • Sara Saeidi,
  • Mohsen Aliakbarian,
  • Amin Dalili,
  • Tomohisa Shoko,
  • Mitsuaki Kojima,
  • Raira Nakamoto,
  • Semra Demirli Atici,
  • Gizem Kilinc Tuncer,
  • Tayfun Kaya,
  • Spiros G. Delis,
  • Stefano Rossi,
  • Biagio Picardi,
  • Simone Rossi del Monte,
  • Tania Triantafyllou,
  • Dimitrios Theodorou,
  • Tadeja Pintar,
  • Jure Salobir,
  • Dimitrios K. Manatakis,
  • Nikolaos Tasis,
  • Vasileios Acheimastos,
  • Orestis Ioannidis,
  • Lydia Loutzidou,
  • Savvas Symeonidis,
  • Tiago Correia de Sá,
  • Mónica Rocha,
  • Tommaso Guagni,
  • Desiré Pantalone,
  • Gherardo Maltinti,
  • Vladimir Khokha,
  • Wafaa Abdel-elsalam,
  • Basma Ghoneim,
  • José Antonio López-Ruiz,
  • Yasin Kara,
  • Syaza Zainudin,
  • Firdaus Hayati,
  • Nornazirah Azizan,
  • Victoria Tan Phooi Khei,
  • Rebecca Choy Xin Yi,
  • Harivinthan Sellappan,
  • Zaza Demetrashvili,
  • Nika Lekiashvili,
  • Ana Tvaladze,
  • Caterina Froiio,
  • Daniele Bernardi,
  • Luigi Bonavina,
  • Angeles Gil-Olarte,
  • Sebastiano Grassia,
  • Estela Romero-Vargas,
  • Francesco Bianco,
  • Andrew A. Gumbs,
  • Agron Dogjani,
  • Ferdinando Agresta,
  • Andrey Litvin,
  • Zsolt J. Balogh,
  • George Gendrikson,
  • Costanza Martino,
  • Dimitrios Damaskos,
  • Nikolaos Pararas,
  • Andrew Kirkpatrick,
  • Mikhail Kurtenkov,
  • Felipe Couto Gomes,
  • Adolfo Pisanu,
  • Oreste Nardello,
  • Fabrizio Gambarini,
  • Hager Aref,
  • Nicola de’ Angelis,
  • Vanni Agnoletti,
  • Antonio Biondi,
  • Marco Vacante,
  • Giulia Griggio,
  • Roberta Tutino,
  • Marco Massani,
  • Giovanni Bisetto,
  • Savino Occhionorelli,
  • Dario Andreotti,
  • Domenico Lacavalla,
  • Walter L. Biffl,
  • Fausto Catena

DOI
https://doi.org/10.1186/s13017-022-00466-4
Journal volume & issue
Vol. 17, no. 1
pp. 1 – 16

Abstract

Read online

Abstract Background The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands. Graphical abstract

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