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

World J Emerg Surg. 2025 Feb 25;20(1):16. doi: 10.1186/s13017-025-00591-w.

Abstract

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.

Trial registration: ClinicalTrials.gov NCT04542312.

Keywords: Acute cholecystitis; Covid-19; Emergency; Laparoscopic cholecystectomy; Management; Mortality; Sars-CoV-2.

Publication types

  • Multicenter Study
  • Review

MeSH terms

  • Aged
  • COVID-19* / complications
  • COVID-19* / epidemiology
  • COVID-19* / mortality
  • Cholecystitis, Acute* / mortality
  • Cholecystitis, Acute* / surgery
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • SARS-CoV-2

Associated data

  • ClinicalTrials.gov/NCT04542312