{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T07:06:31Z","timestamp":1791875191923,"version":"4.3.4"},"reference-count":43,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,5,31]],"date-time":"2017-05-31T00:00:00Z","timestamp":1496188800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Japanese Society of Hepato-Biliary-Pancreatic Surgery"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Although early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An international multicentric retrospective observational study was conducted over a 2\u2010year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index (<jats:styled-content style=\"fixed-case\">CCI<\/jats:styled-content>) scores below and above 6 (<jats:italic>P<\/jats:italic> &lt; 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0\u20133 days after admission (<jats:italic>P<\/jats:italic> &lt; 0.01). Multiple regression analysis revealed <jats:styled-content style=\"fixed-case\">CCI<\/jats:styled-content> and low body mass index &lt;20 as predictive factors of 30\u2010day mortality in Grade I+<jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30\u2010day mortality in Grade <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> patients. In Grade <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Even patients with Grade <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder drainage may have a therapeutic role in subgroups with higher <jats:styled-content style=\"fixed-case\">CCI<\/jats:styled-content> or higher disease severity.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhbp.456","type":"journal-article","created":{"date-parts":[[2017,4,17]],"date-time":"2017-04-17T07:32:58Z","timestamp":1492414378000},"page":"346-361","source":"Crossref","is-referenced-by-count":98,"title":["Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan\u2010Taiwan multicenter cohort study"],"prefix":"10.1002","volume":"24","author":[{"given":"Itaru","family":"Endo","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadahiro","family":"Takada","sequence":"additional","affiliation":[{"name":"Department of Surgery Teikyo University School of Medicine Tokyo 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