Background
The most common indication for cholecystectomy is acute cholecystitis, a condition associated with significant morbidity and mortality. Several clinical tools have been developed to aid pre-operative risk stratification. However, these scores have limited predictive ability in older, comorbid patients. The aim of this study was to investigate the predictive capability of the novel pMDRS (preoperative Multi Domain Risk Stratification) model in older patients with acute cholecystitis.
Methods
Data from older patients admitted to a tertiary hospital between January 2021 & December 2022 with a diagnosis of acute cholecystitis and underwent a cholecystectomy was analysed. The model was applied retrospectively, and patients were risk stratified to low, moderate, and high-risk groups. Selected post-operative outcomes of interest were analysed against the risk groups using regression models.
Results
Multivariate analysis demonstrated prolonged hospital stay for the high-risk group, incidence rate ratio (IRR)2.67,(95%CI1.38-5.17) and for the moderate-risk group, 1.90(1.16-3.11) compared with the low-risk group. There were more medical complications in the high-risk group, odds ratio (OR)5.37, (95%CI,1.05-28.03) and moderate-group 2.73, (1.27-6.45) and more surgical complications in the high (OR, 95%CI) 1.60, (0.40-6.38) and moderate 1.65, (0.65-4.16) groups compared to low-risk groups. Medical Emergency Team calls (METc) demonstrated similar results in both high and moderate-risk groups (OR,95%CI 24.28, 2.96-198.93 and 7.10, 1.29-38.96).
Conclusion
The pMDRS model positively correlated with LOS, medical complications and METc. Surgical complications failed to demonstrate a significant relationship after adjustments. A larger sample is required to evaluate the model’s ability to predict mortality and functional outcomes.