PERIOPERATIVE PREDICTORS OF ACUTE CHOLECYSTITIS AFTER CARDIOVASCULAR-SURGERY

Objective: To determine the incidence, diagnostic features, and periop erative predictors of acute cholecystitis after cardiovascular surgery . Design: Inception cohort study. Setting: A tertiary care 54-bed card iothoracic ICU, Patients: All patients admitted to an ICU after cardio vascular surgery during a 42-month period. Intervention: Collection of relevant preoperative, operative, and ICU data From a database and me dical charts. Primary outcome: Postoperative acute cholecystitis (AC), Results Out of 11,330 admissions, 876 patients stared in the ICU more than 7 days and 30 of them (3%) developed postoperative AC, AC was di agnosed a median of 26 days after cardiovascular surgery (interquartil e range, 11 to 41 days). All patients with AC developed at least two c riteria of the systemic inflammatory response syndrome (SIRS), and 16 of them (53%) were vasopressor-dependent on the day of diagnosis. Tren ds in biochemical testing of liver function were not diagnostic for AC , Death occurred in seven of 17 patients (41%) who underwent cholecyst ectomy, three of nine patients (33%) treated with percutaneous cholecy stostomy, and one of four patients (25%) treated conservatively (p=not significant). Specific earlier predictors of AC were arterial vascula r disease, preoperative oxygen delivery less than 430 mL/min . m(2,) l onger times on cardiopulmonary bypass, surgical re-exploration, ICU co urse complicated by cardiac arrhythmia, mechanical ventilation greater than or equal to 3 days, bacteremia, and nosocomial infections. Concl usion: The incidence of AC is low after cardiovascular surgery. Althou gh SIRS and hemodynamic instability were common at the time of diagnos is, the delayed occurrence and lack of specificity of these features f or AC limited their utility for early diagnosis. Specific predictors o f AC should be sought in the ICU setting to identify; patients who are at risk for AC after cardiovascular surgery. When identified, such pr edictors can prompt earlier diagnosis and treatment. Further evaluatio n of the selection criteria for different treatment options is needed in order to decrease the morbidity and mortality associated with AC.