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World J Emerg Surg
. 2025 Feb 25;20(1):16.
doi: 10.1186/s13017-025-00591-w. COVID-19 infection is a significant risk factor for death in patients presenting with acute cholecystitis: a secondary analysis of the ChoCO-W cohort study
Belinda De Simone 1 2 , Fikri M Abu-Zidan 3 , Lucienne Kasongo 4 , Ernest E Moore 5 , Mauro Podda 6 , Massimo Sartelli 7 , Arda Isik 8 , Miklosh Bala 9 , Raul Coimbra 10 , Zsolt J Balogh 11 , Kemal Rasa 12 , Francesco Marchegiani 13 , Carlo Alberto Schena 14 , Nicola DèAngelis 14 , Marcello Di Martino 15 16 , Luca Ansaloni 17 , Federico Coccolini 18 , Andrew A Gumbs 19 , Walter L Biffl 20 , Emmanouil Pikoulis 21 , Nikolaos Pararas 21 , Elie Chouillard 22 ; ChoCO Collaborative group; Fausto Catena 23 24
Collaborators, Affiliations
Background: During the coronavirus disease (COVID-19) pandemic, there has been a surge in cases of acute cholecystitis. The ChoCO-W global prospective study reported a higher incidence of gangrenous cholecystitis and adverse outcomes in COVID-19 patients. Through this secondary analysis of the ChoCO-W study data, we aim to identify significant risk factors for mortality in patients with acute cholecystitis during the COVID-19 pandemic, emphasizing the role of COVID-19 infection in patient outcomes and treatment efficacy."
Methods: The ChoCO-W global prospective study reported data from 2546 patients collected at 218 centers from 42 countries admitted with acute cholecystitis during the COVID-19 pandemic, from October 1, 2020, to October 31, 2021. Sixty-four of them died. Nonparametric statistical univariate analysis was performed to compare patients who died and patients who survived. Significant factors were then entered into a logistic regression model to define factors predicting mortality.
Results: The significant independent factors that predicted death in the logistic regression model with were COVID-19 infection (p < 0.001), postoperative complications (p < 0.001), and type (open/laparoscopic) of surgical intervention (p = 0.003). The odds of death increased 5 times with the COVID-19 infection, 6 times in the presence of complications, and it was reduced by 86% with adequate source control. Survivors predominantly underwent urgent laparoscopic cholecystectomy (52.3% vs. 23.4%).
Conclusions: COVID-19 was an independent risk factor for death in patients with acute cholecystitis. Early laparoscopic cholecystectomy has emerged as the cornerstone of treatment for hemodynamically stable patients.
Keywords: Acute cholecystitis; Covid-19; Emergency; Laparoscopic cholecystectomy; Management; Mortality; Sars-CoV-2.
. 2025 Feb 25;20(1):16.
doi: 10.1186/s13017-025-00591-w. COVID-19 infection is a significant risk factor for death in patients presenting with acute cholecystitis: a secondary analysis of the ChoCO-W cohort study
Belinda De Simone 1 2 , Fikri M Abu-Zidan 3 , Lucienne Kasongo 4 , Ernest E Moore 5 , Mauro Podda 6 , Massimo Sartelli 7 , Arda Isik 8 , Miklosh Bala 9 , Raul Coimbra 10 , Zsolt J Balogh 11 , Kemal Rasa 12 , Francesco Marchegiani 13 , Carlo Alberto Schena 14 , Nicola DèAngelis 14 , Marcello Di Martino 15 16 , Luca Ansaloni 17 , Federico Coccolini 18 , Andrew A Gumbs 19 , Walter L Biffl 20 , Emmanouil Pikoulis 21 , Nikolaos Pararas 21 , Elie Chouillard 22 ; ChoCO Collaborative group; Fausto Catena 23 24
Collaborators, Affiliations
- PMID: 40001181
- PMCID: PMC11853863
- DOI: 10.1186/s13017-025-00591-w
Background: During the coronavirus disease (COVID-19) pandemic, there has been a surge in cases of acute cholecystitis. The ChoCO-W global prospective study reported a higher incidence of gangrenous cholecystitis and adverse outcomes in COVID-19 patients. Through this secondary analysis of the ChoCO-W study data, we aim to identify significant risk factors for mortality in patients with acute cholecystitis during the COVID-19 pandemic, emphasizing the role of COVID-19 infection in patient outcomes and treatment efficacy."
Methods: The ChoCO-W global prospective study reported data from 2546 patients collected at 218 centers from 42 countries admitted with acute cholecystitis during the COVID-19 pandemic, from October 1, 2020, to October 31, 2021. Sixty-four of them died. Nonparametric statistical univariate analysis was performed to compare patients who died and patients who survived. Significant factors were then entered into a logistic regression model to define factors predicting mortality.
Results: The significant independent factors that predicted death in the logistic regression model with were COVID-19 infection (p < 0.001), postoperative complications (p < 0.001), and type (open/laparoscopic) of surgical intervention (p = 0.003). The odds of death increased 5 times with the COVID-19 infection, 6 times in the presence of complications, and it was reduced by 86% with adequate source control. Survivors predominantly underwent urgent laparoscopic cholecystectomy (52.3% vs. 23.4%).
Conclusions: COVID-19 was an independent risk factor for death in patients with acute cholecystitis. Early laparoscopic cholecystectomy has emerged as the cornerstone of treatment for hemodynamically stable patients.
Keywords: Acute cholecystitis; Covid-19; Emergency; Laparoscopic cholecystectomy; Management; Mortality; Sars-CoV-2.