SSAT - COMPARING THE MANAGEMENT AND OUTCOMES OF PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS ADMITTED TO SURGICAL VERSUS MEDICAL WARDS

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COMPARING THE MANAGEMENT AND OUTCOMES OF PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS ADMITTED TO SURGICAL VERSUS MEDICAL WARDS
Yodsakorn Anukulkarnkusol^*¹, Wiriyaporn Ridtitid^2,3, Natsida Rathanaviriyachai^2,3, Phonthep Angsuwatcharakon^3,4, Parit Mekaroonkamol^2,3, Pradermchai Kongkam^2,3, Rungsun Rerknimitr^2,3
¹Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; ²Division of Gastroenterology, Department of medicine, Faculty of medicine, Chulalongkorn University, Bangkok, Thailand; ³Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; ⁴Division of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Abstract
Background and Aims: Early cholecystectomy (CYY) is recommended in patients with acute calculous cholecystitis (ACC) to prevent recurrent attacks. Although ACC is a surgical disease, certain patients with ACC are admitted to internal medicine ward mainly for the requirement of ERCP for common bile duct stone (CBD) clearance. Our study aimed to compare the clinical outcomes of patients with ACC who were primarily admitted to surgical versus internal medicine wards.
Methods: Between 2013 and 2023, a retrospective review of 923 medical records at our institution identified 625 patients with ACC, who were included in this study (Figure). Patients were divided into two groups based on their admission to either the surgery or internal medicine wards. We compared their characteristics, management and clinical outcomes between the two groups.
Results: Of 625 patients, 91 (14.6%) and 534 (85.4%) patients with ACC were admitted to surgical and internal medicine wards, respectively. There were no statistical differences in mean age (63�16.5 vs. 62.6�18.9 years; p=0.20), male gender (34.1% vs. 45.1%; p=0.06), Charlson comorbidity index (CCI) (CCI?6: 9.9% vs. 12.7% and CCI<6: 90.1% vs. 87.3%; p=0.55), severity of ACC (Grade 1: 52.7% vs. 48.1%, Grade 2: 40.7% vs. 41%, Grade 3 : 6.6% vs.10.9%; p=0.39), mean duration of onset to admission (2.2�1.9 vs. 2.7�2.3 days; p=0.08), intensive care unit admission (1.1% vs. 2.6%; p=0.38) between the two groups, except for the presence of concomitant cholangitis which was higher in those admitted to internal medicine ward [24% (128/534) vs. 6.6% (6/91); p<0.001] (Table). The rate of same-admission cholecystectomy was significantly higher in those admitted to surgical ward compared to those admitted to internal medicine ward [72.5% (66/91) vs. 10.3% (55/534), p<0.001], with comparable rates of post-operative adverse events (11.9% vs. 12.9%; p=0.80) and mean length of hospitalization between the two groups (7.5�7.1 vs. 11.5�8.4 days; p=0.21). The rate of ERCP performed for concomitant CBD stone or cholangitis was higher in those admitted to internal medicine ward compared to those admitted to surgical ward [40.4% (216/534) vs. 5.5% (5/91); p<0.001]. In patients awaiting cholecystectomy, those admitted to internal medicine ward had significantly longer time to cholecystectomy [113.1�185.1 vs. 26.1�61.2 days, p=0.01] and higher rates of overall biliary events during the waiting period for CCY compared to those admitted to surgical ward (10.1% vs. 3.3%; p=0.04).
Conclusions: Patients with ACC admitted to surgical ward had significantly higher rates of same-admission CCY with lower rates of biliary events during the waiting period for CCY compared to those admitted to internal medicine ward. Internal medicine ward received more ACC patients with concomitant cholangitis who need ERCP.

Figure. Flow chart of study

Table. Baseline characteristics and clinical outcomes of patients with acute calculous cholecystitis who were admitted to surgical versus internal medicine wards (n=625)

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