Abstract：
BACKGROUND: The impact of different phases of COVID-19 infection on outcomes from acute calculous cholecystitis (ACC) is not well understood. Therefore, we examined outcomes of acute cholecystitis during the COVID-19 pandemic, comparing the effect of different treatment modalities and COVID-19 infection status. We hypothesized that patients with acute COVID-19 would have worse outcomes than COVID-negative patients, but there would be no difference between COVID-negative and COVID-recovered patients.
METHODS: We used 2020-2023 National COVID Cohort Collaborative data to identify adults with ACC. Treatment (antibiotics-only, cholecystostomy tube, or cholecystectomy) and COVID-19 status (negative, active, or recovered) were collected. Treatment failure of nonoperative managements was noted. Adjusted analysis using a series of generalized linear models controlled for confounders (age, sex, body mass index, Charlson comorbidity index, severity at presentation, and year) to better assess differences in outcomes among treatment groups, as well as between COVID-19 groups.
RESULTS: In total, 32,433 patients (skewed count) were included: 29,749 COVID-negative, 2112 COVID-active, and 572 (skewed count) 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 length of stay than COVID-negative and COVID-recovered. Adjusted analysis revealed cholecystectomy carried lower odds of mortality for COVID-active and COVID-negative patients than antibiotics or cholecystostomy. COVID-recovered patients\' mortality was unaffected by treatment modality. Treatment failure from antibiotics was more common for COVID-negative patients.
CONCLUSIONS: Acute cholecystitis outcomes are affected by phase of COVID-19 infection and treatment modality. Cholecystectomy does not lead to worse outcomes for COVID-active and COVID-recovered patients than nonoperative treatments; thus, these patients can be considered for cholecystectomy if their physiology is not prohibitive.
METHODS: We used 2020-2023 National COVID Cohort Collaborative data to identify adults with ACC. Treatment (antibiotics-only, cholecystostomy tube, or cholecystectomy) and COVID-19 status (negative, active, or recovered) were collected. Treatment failure of nonoperative managements was noted. Adjusted analysis using a series of generalized linear models controlled for confounders (age, sex, body mass index, Charlson comorbidity index, severity at presentation, and year) to better assess differences in outcomes among treatment groups, as well as between COVID-19 groups.
RESULTS: In total, 32,433 patients (skewed count) were included: 29,749 COVID-negative, 2112 COVID-active, and 572 (skewed count) 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 length of stay than COVID-negative and COVID-recovered. Adjusted analysis revealed cholecystectomy carried lower odds of mortality for COVID-active and COVID-negative patients than antibiotics or cholecystostomy. COVID-recovered patients\' mortality was unaffected by treatment modality. Treatment failure from antibiotics was more common for COVID-negative patients.
CONCLUSIONS: Acute cholecystitis outcomes are affected by phase of COVID-19 infection and treatment modality. Cholecystectomy does not lead to worse outcomes for COVID-active and COVID-recovered patients than nonoperative treatments; thus, these patients can be considered for cholecystectomy if their physiology is not prohibitive.
摘要：
背景：COVID-19感染的不同阶段对急性结石性胆囊炎预后的影响尚不清楚。因此,我们检查了COVID-19大流行期间急性胆囊炎的结局，比较不同治疗方式的效果以及COVID-19感染状况。我们假设急性COVID-19患者的预后会比COVID阴性患者差，但COVID阴性和COVID康复患者之间没有差异。
方法：我们利用2020-2023年国家COVID队列协作数据来识别患有急性结石性胆囊炎的成年人。治疗（仅抗生素，胆囊造口管,或胆囊切除术)，和COVID-19状态(阴性，活跃,或回收)被收集。注意到非手术管理的治疗失败。使用一系列控制混杂因素的广义线性模型进行调整分析(年龄，性别,BMI,Charlson合并症指数,演示时的严重性，和年份)以更好地评估治疗组之间的结果差异，以及COVID-19组之间。
结果：总计，包括32,433¥患者：29,749COVID阴性，2,112个COVID活性物质，572¥COVID回收。COVID活性物质在出现时败血症的发生率更高。COVID阴性更常接受胆囊切除术。未调整,COVID活性物质具有更高的30天死亡率，30天并发症,LOS长于COVID阴性和COVID恢复。调整后的分析显示，胆囊切除术对COVID活跃和COVID阴性患者的死亡率较低，与抗生素或胆囊造口术相比。COVID康复患者的死亡率不受治疗方式的影响。抗生素治疗失败在COVID阴性患者中更为常见。
结论：急性胆囊炎结局受COVID-19感染阶段和治疗方式的影响。对于COVID活跃和COVID康复的患者，胆囊切除术不会导致更差的预后，与非手术治疗相比，因此，如果这些患者的生理机能不受限制，可以考虑进行胆囊切除术。
方法：我们利用2020-2023年国家COVID队列协作数据来识别患有急性结石性胆囊炎的成年人。治疗（仅抗生素，胆囊造口管,或胆囊切除术)，和COVID-19状态(阴性，活跃,或回收)被收集。注意到非手术管理的治疗失败。使用一系列控制混杂因素的广义线性模型进行调整分析(年龄，性别,BMI,Charlson合并症指数,演示时的严重性，和年份)以更好地评估治疗组之间的结果差异，以及COVID-19组之间。
结果：总计，包括32,433¥患者：29,749COVID阴性，2,112个COVID活性物质，572¥COVID回收。COVID活性物质在出现时败血症的发生率更高。COVID阴性更常接受胆囊切除术。未调整,COVID活性物质具有更高的30天死亡率，30天并发症,LOS长于COVID阴性和COVID恢复。调整后的分析显示，胆囊切除术对COVID活跃和COVID阴性患者的死亡率较低，与抗生素或胆囊造口术相比。COVID康复患者的死亡率不受治疗方式的影响。抗生素治疗失败在COVID阴性患者中更为常见。
结论：急性胆囊炎结局受COVID-19感染阶段和治疗方式的影响。对于COVID活跃和COVID康复的患者，胆囊切除术不会导致更差的预后，与非手术治疗相比，因此，如果这些患者的生理机能不受限制，可以考虑进行胆囊切除术。
