Browsing by Author "Damaskos, Dimitrios"

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    Correction: ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings
    (2023-11-27) Frassini, Simone; Cobianchi, Lorenzo; Fugazzola, Paola; Biffl, Walter L.; Coccolini, Federico; Damaskos, Dimitrios; Moore, Ernest E.; Kluger, Yoram; Ceresoli, Marco; Coimbra, Raul; Davies, Justin; Kirkpatrick, Andrew; Di Carlo, Isidoro; Hardcastle, Timothy C.; Isik, Arda; Chiarugi, Massimo; Gurusamy, Kurinchi; Maier, Ronald V.; Segovia Lohse, Helmut A.; Jeekel, Hans; Boermeester, Marja A.; Abu-Zidan, Fikri; Inaba, Kenji; Weber, Dieter G.; Augustin, Goran; Bonavina, Luigi; Velmahos, George; Sartelli, Massimo; Di Saverio, Salomone; Ten Broek, Richard P. G.; Granieri, Stefano; Dal Mas, Francesca; Farè, Camilla N.; Peverada, Jacopo; Zanghì, Simone; Viganò, Jacopo; Tomasoni, Matteo; Dominioni, Tommaso; Cicuttin, Enrico; Hecker, Andreas; Tebala, Giovanni D.; Galante, Joseph M.; Wani, Imtiaz; Khokha, Vladimir; Sugrue, Michael; Scalea, Thomas M.; Tan, Edward; Malangoni, Mark A.; Pararas, Nikolaos; Podda, Mauro; De Simone, Belinda; Ivatury, Rao; Cui, Yunfeng; Kashuk, Jeffry; Peitzman, Andrew; Kim, Fernando; Pikoulis, Emmanouil; Sganga, Gabriele; Chiara, Osvaldo; Kelly, Michael D.; Marzi, Ingo; Picetti, Edoardo; Agnoletti, Vanni; De’Angelis, Nicola; Campanelli, Giampiero; de Moya, Marc; Litvin, Andrey; Martínez-Pérez, Aleix; Sall, Ibrahima; Rizoli, Sandro; Tomadze, Gia; Sakakushev, Boris; Stahel, Philip F.; Civil, Ian; Shelat, Vishal; Costa, David; Chichom-Mefire, Alain; Latifi, Rifat; Chirica, Mircea; Amico, Francesco; Pardhan, Amyn; Seenarain, Vidya; Boyapati, Nikitha; Hatz, Basil; Ackermann, Travis; Abeyasundara, Sandun; Fenton, Linda; Plani, Frank; Sarvepalli, Rohit; Rouhbakhshfar, Omid; Caleo, Pamela; Ho-Ching Yau, Victor; Clement, Kristenne; Christou, Erasmia; Castillo, Ana M. G.; Gosal, Preet K. S.; Balasubramaniam, Sunder; Hsu, Jeremy; Banphawatanarak, Kamon; Pisano, Michele; Toro, Adriana; Michele, Altomare; Cioffi, Stefano P. B.; Spota, Andrea; Catena, Fausto; Ansaloni, Luca
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    COVID-19 the showdown for mass casualty preparedness and management: the Cassandra Syndrome
    (2020-04-09) Coccolini, Federico; Sartelli, Massimo; Kluger, Yoram; Pikoulis, Emmanouil; Karamagioli, Evika; Moore, Ernest E; Biffl, Walter L; Peitzman, Andrew; Hecker, Andreas; Chirica, Mircea; Damaskos, Dimitrios; Ordonez, Carlos; Vega, Felipe; Fraga, Gustavo P; Chiarugi, Massimo; Di Saverio, Salomone; Kirkpatrick, Andrew W; Abu-Zidan, Fikri; Mefire, Alain C; Leppaniemi, Ari; Khokha, Vladimir; Sakakushev, Boris; Catena, Rodolfo; Coimbra, Raul; Ansaloni, Luca; Corbella, Davide; Catena, Fausto
    Abstract Since December 2019, the world is potentially facing one of the most difficult infectious situations of the last decades. COVID-19 epidemic warrants consideration as a mass casualty incident (MCI) of the highest nature. An optimal MCI/disaster management should consider all four phases of the so-called disaster cycle: mitigation, planning, response, and recovery. COVID-19 outbreak has demonstrated the worldwide unpreparedness to face a global MCI. This present paper thus represents a call for action to solicitate governments and the Global Community to actively start effective plans to promote and improve MCI management preparedness in general, and with an obvious current focus on COVID-19.
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    ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings
    (2023-07-26) Frassini, Simone; Cobianchi, Lorenzo; Fugazzola, Paola; Biffl, Walter L.; Coccolini, Federico; Damaskos, Dimitrios; Moore, Ernest E.; Kluger, Yoram; Ceresoli, Marco; Coimbra, Raul; Davies, Justin; Kirkpatrick, Andrew; Di Carlo, Isidoro; Hardcastle, Timothy C.; Isik, Arda; Chiarugi, Massimo; Gurusamy, Kurinchi; Maier, Ronald V.; Segovia Lohse, Helmut A.; Jeekel, Hans; Boermeester, Marja A.; Abu-Zidan, Fikri; Inaba, Kenji; Weber, Dieter G.; Augustin, Goran; Bonavina, Luigi; Velmahos, George; Sartelli, Massimo; Di Saverio, Salomone; Ten Broek, Richard P. G.; Granieri, Stefano; Dal Mas, Francesca; Farè, Camilla N.; Peverada, Jacopo; Zanghì, Simone; Viganò, Jacopo; Tomasoni, Matteo; Dominioni, Tommaso; Cicuttin, Enrico; Hecker, Andreas; Tebala, Giovanni D.; Galante, Joseph M.; Wani, Imtiaz; Khokha, Vladimir; Sugrue, Michael; Scalea, Thomas M.; Tan, Edward; Malangoni, Mark A.; Pararas, Nikolaos; Podda, Mauro; De Simone, Belinda; Ivatury, Rao; Cui, Yunfeng; Kashuk, Jeffry; Peitzman, Andrew; Kim, Fernando; Pikoulis, Emmanouil; Sganga, Gabriele; Chiara, Osvaldo; Kelly, Michael D.; Marzi, Ingo; Picetti, Edoardo; Agnoletti, Vanni; De’Angelis, Nicola; Campanelli, Giampiero; de Moya, Marc; Litvin, Andrey; Martínez-Pérez, Aleix; Sall, Ibrahima; Rizoli, Sandro; Tomadze, Gia; Sakakushev, Boris; Stahel, Philip F.; Civil, Ian; Shelat, Vishal; Costa, David; Chichom-Mefire, Alain; Latifi, Rifat; Chirica, Mircea; Amico, Francesco; Pardhan, Amyn; Seenarain, Vidya; Boyapati, Nikitha; Hatz, Basil; Ackermann, Travis; Abeyasundara, Sandun; Fenton, Linda; Plani, Frank; Sarvepalli, Rohit; Rouhbakhshfar, Omid; Caleo, Pamela; Ho-Ching Yau, Victor; Clement, Kristenne; Christou, Erasmia; Castillo, Ana M. G.; Gosal, Preet K. S.; Balasubramaniam, Sunder; Hsu, Jeremy; Banphawatanarak, Kamon; Pisano, Michele; Adriana, Toro; Michele, Altomare; Cioffi, Stefano P. B.; Spota, Andrea; Catena, Fausto; Ansaloni, Luca
    Abstract Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.
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    Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document
    (2022-10-12) Podda, Mauro; De Simone, Belinda; Ceresoli, Marco; Virdis, Francesco; Favi, Francesco; Wiik Larsen, Johannes; Coccolini, Federico; Sartelli, Massimo; Pararas, Nikolaos; Beka, Solomon G.; Bonavina, Luigi; Bova, Raffaele; Pisanu, Adolfo; Abu-Zidan, Fikri; Balogh, Zsolt; Chiara, Osvaldo; Wani, Imtiaz; Stahel, Philip; Di Saverio, Salomone; Scalea, Thomas; Soreide, Kjetil; Sakakushev, Boris; Amico, Francesco; Martino, Costanza; Hecker, Andreas; de’Angelis, Nicola; Chirica, Mircea; Galante, Joseph; Kirkpatrick, Andrew; Pikoulis, Emmanouil; Kluger, Yoram; Bensard, Denis; Ansaloni, Luca; Fraga, Gustavo; Civil, Ian; Tebala, Giovanni D.; Di Carlo, Isidoro; Cui, Yunfeng; Coimbra, Raul; Agnoletti, Vanni; Sall, Ibrahima; Tan, Edward; Picetti, Edoardo; Litvin, Andrey; Damaskos, Dimitrios; Inaba, Kenji; Leung, Jeffrey; Maier, Ronald; Biffl, Walt; Leppaniemi, Ari; Moore, Ernest; Gurusamy, Kurinchi; Catena, Fausto
    Abstract Background In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. Methods Using a modified Delphi method, we sought to explore ongoing areas of controversy in the NOM of splenic trauma and reach a consensus among a group of 48 international experts from five continents (Africa, Europe, Asia, Oceania, America) concerning optimal follow-up strategies in patients with splenic injuries treated with NOM. Results Consensus was reached on eleven clinical research questions and 28 recommendations with an agreement rate ≥ 80%. Mobilization after 24 h in low-grade splenic trauma patients (WSES Class I, AAST Grades I–II) was suggested, while in patients with high-grade splenic injuries (WSES Classes II–III, AAST Grades III–V), if no other contraindications to early mobilization exist, safe mobilization of the patient when three successive hemoglobins 8 h apart after the first are within 10% of each other was considered safe according to the panel. The panel suggests adult patients to be admitted to hospital for 1 day (for low-grade splenic injuries—WSES Class I, AAST Grades I–II) to 3 days (for high-grade splenic injuries—WSES Classes II–III, AAST Grades III–V), with those with high-grade injuries requiring admission to a monitored setting. In the absence of specific complications, the panel suggests DVT and VTE prophylaxis with LMWH to be started within 48–72 h from hospital admission. The panel suggests splenic artery embolization (SAE) as the first-line intervention in patients with hemodynamic stability and arterial blush on CT scan, irrespective of injury grade. Regarding patients with WSES Class II blunt splenic injuries (AAST Grade III) without contrast extravasation, a low threshold for SAE has been suggested in the presence of risk factors for NOM failure. The panel also suggested angiography and eventual SAE in all hemodynamically stable adult patients with WSES Class III injuries (AAST Grades IV–V), even in the absence of CT blush, especially when concomitant surgery that requires change of position is needed. Follow-up imaging with contrast-enhanced ultrasound/CT scan in 48–72 h post-admission of trauma in splenic injuries WSES Class II (AAST Grade III) or higher treated with NOM was considered the best strategy for timely detection of vascular complications. Conclusion This consensus document could help guide future prospective studies aiming at validating the suggested strategies through the implementation of prospective trauma databases and the subsequent production of internationally endorsed guidelines on the issue.
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    The 2023 WSES guidelines on the management of trauma in elderly and frail patients
    (2024-05-31) De Simone, Belinda; Chouillard, Elie; Podda, Mauro; Pararas, Nikolaos; de Carvalho Duarte, Gustavo; Fugazzola, Paola; Birindelli, Arianna; Coccolini, Federico; Polistena, Andrea; Sibilla, Maria G.; Kruger, Vitor; Fraga, Gustavo P.; Montori, Giulia; Russo, Emanuele; Pintar, Tadeja; Ansaloni, Luca; Avenia, Nicola; Di Saverio, Salomone; Leppäniemi, Ari; Lauretta, Andrea; Sartelli, Massimo; Puzziello, Alessandro; Carcoforo, Paolo; Agnoletti, Vanni; Bissoni, Luca; Isik, Arda; Kluger, Yoram; Moore, Ernest E.; Romeo, Oreste M.; Abu-Zidan, Fikri M.; Beka, Solomon G.; Weber, Dieter G.; Tan, Edward C. T. H.; Paolillo, Ciro; Cui, Yunfeng; Kim, Fernando; Picetti, Edoardo; Di Carlo, Isidoro; Toro, Adriana; Sganga, Gabriele; Sganga, Federica; Testini, Mario; Di Meo, Giovanna; Kirkpatrick, Andrew W.; Marzi, Ingo; déAngelis, Nicola; Kelly, Michael D.; Wani, Imtiaz; Sakakushev, Boris; Bala, Miklosh; Bonavina, Luigi; Galante, Joseph M.; Shelat, Vishal G.; Cobianchi, Lorenzo; Mas, Francesca D.; Pikoulis, Manos; Damaskos, Dimitrios; Coimbra, Raul; Dhesi, Jugdeep; Hoffman, Melissa R.; Stahel, Philip F.; Maier, Ronald V.; Litvin, Andrey; Latifi, Rifat; Biffl, Walter L.; Catena, Fausto
    Abstract Background The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. Methods Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. Results The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient’s directives, family feelings and representatives' desires, and all decisions should be shared. Conclusions The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes. Graphical abstract
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    The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?
    (2022-12-16) De Simone, Belinda; Abu-Zidan, Fikri M.; Chouillard, Elie; Di Saverio, Salomone; Sartelli, Massimo; Podda, Mauro; Gomes, Carlos A.; Moore, Ernest E.; Moug, Susan J.; Ansaloni, Luca; Kluger, Yoram; Coccolini, Federico; Landaluce-Olavarria, Aitor; Estraviz-Mateos, Begoña; Uriguen-Etxeberria, Ana; Giordano, Alessio; Luna, Alfonso P.; Amín, Luz A. H.; Hernández, Adriana M. P.; Shabana, Amanda; Dzulkarnaen, Zakaria A.; Othman, Muhammad A.; Sani, Mohamad I.; Balla, Andrea; Scaramuzzo, Rosa; Lepiane, Pasquale; Bottari, Andrea; Staderini, Fabio; Cianchi, Fabio; Cavallaro, Andrea; Zanghì, Antonio; Cappellani, Alessandro; Campagnacci, Roberto; Maurizi, Angela; Martinotti, Mario; Ruggieri, Annamaria; Jusoh, Asri C.; Rahman, Karim A.; Zulkifli, Anis S. M.; Petronio, Barbara; Matías-García, Belén; Quiroga-Valcárcel, Ana; Mendoza-Moreno, Fernando; Atanasov, Boyko; Campanile, Fabio C.; Vecchioni, Ilaria; Cardinali, Luca; Travaglini, Grazia; Sebastiani, Elisa; Chooklin, Serge; Chuklin, Serhii; Cianci, Pasquale; Restini, Enrico; Capuzzolo, Sabino; Currò, Giuseppe; Filippo, Rosalinda; Rispoli, Michele; Aparicio-Sánchez, Daniel; Muñóz-Cruzado, Virginia D.; Barbeito, Sandra D.; Delibegovic, Samir; Kesetovic, Amar; Sasia, Diego; Borghi, Felice; Giraudo, Giorgio; Visconti, Diego; Doria, Emanuele; Santarelli, Mauro; Luppi, Davide; Bonilauri, Stefano; Grossi, Ugo; Zanus, Giacomo; Sartori, Alberto; Piatto, Giacomo; De Luca, Maurizio; Vita, Domenico; Conti, Luigi; Capelli, Patrizio; Cattaneo, Gaetano M.; Marinis, Athanasios; Vederaki, Styliani-Aikaterini; Bayrak, Mehmet; Altıntas, Yasemin; Uzunoglu, Mustafa Y.; Demirbas, Iskender E.; Altinel, Yuksel; Meric, Serhat; Aktimur, Yunus E.; Uymaz, Derya S.; Omarov, Nail; Azamat, Ibrahim; Lostoridis, Eftychios; Nagorni, Eleni-Aikaterini; Pujante, Antonio; Anania, Gabriele; Bombardini, Cristina; Bagolini, Francesco; Gonullu, Emre; Mantoglu, Baris; Capoglu, Recayi; Cappato, Stefano; Muzio, Elena; Colak, Elif; Polat, Suleyman; Koylu, Zehra A.; Altintoprak, Fatih; Bayhan, Zülfü; Akin, Emrah; Andolfi, Enrico; Rezart, Sulce; Kim, Jae I.; Jung, Sung W.; Shin, Yong C.; Enciu, Octavian; Toma, Elena A.; Medas, Fabio; Canu, Gian L.; Cappellacci, Federico; D’Acapito, Fabrizio; Ercolani, Giorgio; Solaini, Leonardo; Roscio, Francesco; Clerici, Federico; Gelmini, Roberta; Serra, Francesco; Rossi, Elena G.; Fleres, Francesco; Clarizia, Guglielmo; Spolini, Alessandro; Ferrara, Francesco; Nita, Gabriela; Sarnari, Jlenia; Gachabayov, Mahir; Abdullaev, Abakar; Poillucci, Gaetano; Palini, Gian M.; Veneroni, Simone; Garulli, Gianluca; Piccoli, Micaela; Pattacini, Gianmaria C.; Pecchini, Francesca; Argenio, Giulio; Armellino, Mariano F.; Brisinda, Giuseppe; Tedesco, Silvia; Fransvea, Pietro; Ietto, Giuseppe; Franchi, Caterina; Carcano, Giulio; Martines, Gennaro; Trigiante, Giuseppe; Negro, Giulia; Vega, Gustavo M.; González, Agustín R.; Ojeda, Leonardo; Piccolo, Gaetano; Bondurri, Andrea; Maffioli, Anna; Guerci, Claudio; Sin, Boo H.; Zuhdi, Zamri; Azman, Azlanudin; Mousa, Hussam; al Bahri, Shadi; Augustin, Goran; Romic, Ivan; Moric, Trpimir; Nikolopoulos, Ioannis; Andreuccetti, Jacopo; Pignata, Giusto; D’Alessio, Rossella; Kenig, Jakub; Skorus, Urszula; Fraga, Gustavo P.; Hirano, Elcio S.; de Lima Bertuol, Jackson V.; Isik, Arda; Kurnaz, Eray; Asghar, Mohammad S.; Afzal, Ameer; Akbar, Ali; Nikolouzakis, Taxiarchis K.; Lasithiotakis, Konstantinos; Chrysos, Emmanuel; Das, Koray; Özer, Nazmi; Seker, Ahmet; Ibrahim, Mohamed; Hamid, Hytham K. S.; Babiker, Ahmed; Bouliaris, Konstantinos; Koukoulis, George; Kolla, Chrysoula-Christina; Lucchi, Andrea; Agostinelli, Laura; Taddei, Antonio; Fortuna, Laura; Agostini, Carlotta; Licari, Leo; Viola, Simona; Callari, Cosimo; Laface, Letizia; Abate, Emmanuele; Casati, Massimiliano; Anastasi, Alessandro; Canonico, Giuseppe; Gabellini, Linda; Tosi, Lorenzo; Guariniello, Anna; Zanzi, Federico; Bains, Lovenish; Sydorchuk, Larysa; Iftoda, Oksana; Sydorchuk, Andrii; Malerba, Michele; Costanzo, Federico; Galleano, Raffaele; Monteleone, Michela; Costanzi, Andrea; Riva, Carlo; Walędziak, Maciej; Kwiatkowski, Andrzej; Czyżykowski, Łukasz; Major, Piotr; Strzałka, Marcin; Matyja, Maciej; Natkaniec, Michal; Valenti, Maria R.; Di Vita, Maria D. P.; Sotiropoulou, Maria; Kapiris, Stylianos; Massalou, Damien; Veroux, Massimiliano; Volpicelli, Alessio; Gioco, Rossella; Uccelli, Matteo; Bonaldi, Marta; Olmi, Stefano; Nardi, Matteo; Livadoti, Giada; Mesina, Cristian; Dumitrescu, Theodor V.; Ciorbagiu, Mihai C.; Ammendola, Michele; Ammerata, Giorgio; Romano, Roberto; Slavchev, Mihail; Misiakos, Evangelos P.; Pikoulis, Emmanouil; Papaconstantinou, Dimitrios; Elbahnasawy, Mohamed; Abdel-elsalam, Sherief; Felsenreich, Daniel M.; Jedamzik, Julia; Michalopoulos, Nikolaos V.; Sidiropoulos, Theodoros A.; Papadoliopoulou, Maria; Cillara, Nicola; Deserra, Antonello; Cannavera, Alessandro; Negoi, Ionuţ; Schizas, Dimitrios; Syllaios, Athanasios; Vagios, Ilias; Gourgiotis, Stavros; Dai, Nick; Gurung, Rekha; Norrey, Marcus; Pesce, Antonio; Feo, Carlo V.; Fabbri, Nicolo’; Machairas, Nikolaos; Dorovinis, Panagiotis; Keramida, Myrto D.; Mulita, Francesk; Verras, Georgios I.; Vailas, Michail; Yalkin, Omer; Iflazoglu, Nidal; Yigit, Direnc; Baraket, Oussama; Ayed, Karim; Ghalloussi, Mohamed h.; Patias, Parmenion; Ntokos, Georgios; Rahim, Razrim; Bala, Miklosh; Kedar, Asaf; Sawyer, Robert G.; Trinh, Anna; Miller, Kelsey; Sydorchuk, Ruslan; Knut, Ruslan; Plehutsa, Oleksandr; Liman, Rumeysa K.; Ozkan, Zeynep; Kader, Saleh A.; Gupta, Sanjay; Gureh, Monika; Saeidi, Sara; Aliakbarian, Mohsen; Dalili, Amin; Shoko, Tomohisa; Kojima, Mitsuaki; Nakamoto, Raira; Atici, Semra D.; Tuncer, Gizem K.; Kaya, Tayfun; Delis, Spiros G.; Rossi, Stefano; Picardi, Biagio; del Monte, Simone R.; Triantafyllou, Tania; Theodorou, Dimitrios; Pintar, Tadeja; Salobir, Jure; Manatakis, Dimitrios K.; Tasis, Nikolaos; Acheimastos, Vasileios; Ioannidis, Orestis; Loutzidou, Lydia; Symeonidis, Savvas; de Sá, Tiago C.; Rocha, Mónica; Guagni, Tommaso; Pantalone, Desiré; Maltinti, Gherardo; Khokha, Vladimir; Abdel-elsalam, Wafaa; Ghoneim, Basma; López-Ruiz, José A.; Kara, Yasin; Zainudin, Syaza; Hayati, Firdaus; Azizan, Nornazirah; Khei, Victoria T. P.; Yi, Rebecca C. X.; Sellappan, Harivinthan; Demetrashvili, Zaza; Lekiashvili, Nika; Tvaladze, Ana; Froiio, Caterina; Bernardi, Daniele; Bonavina, Luigi; Gil-Olarte, Angeles; Grassia, Sebastiano; Romero-Vargas, Estela; Bianco, Francesco; Gumbs, Andrew A.; Dogjani, Agron; Agresta, Ferdinando; Litvin, Andrey; Balogh, Zsolt J.; Gendrikson, George; Martino, Costanza; Damaskos, Dimitrios; Pararas, Nikolaos; Kirkpatrick, Andrew; Kurtenkov, Mikhail; Gomes, Felipe C.; Pisanu, Adolfo; Nardello, Oreste; Gambarini, Fabrizio; Aref, Hager; Angelis, Nicola d.; Agnoletti, Vanni; Biondi, Antonio; Vacante, Marco; Griggio, Giulia; Tutino, Roberta; Massani, Marco; Bisetto, Giovanni; Occhionorelli, Savino; Andreotti, Dario; Lacavalla, Domenico; Biffl, Walter L.; Catena, Fausto
    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