{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:37:00Z","timestamp":1767832620449,"version":"3.49.0"},"reference-count":28,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T00:00:00Z","timestamp":1701302400000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009230","name":"Uppsala County Council","doi-asserted-by":"crossref","award":["No grant number"],"award-info":[{"award-number":["No grant number"]}],"id":[{"id":"10.13039\/501100009230","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100007051","name":"Uppsala University","doi-asserted-by":"crossref","award":["No grant number"],"award-info":[{"award-number":["No grant number"]}],"id":[{"id":"10.13039\/501100007051","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Centre for Research and Development Region G\u00e4vleborg","award":["CFUG-965514"],"award-info":[{"award-number":["CFUG-965514"]}]},{"name":"Centre for Research and Development Region G\u00e4vleborg","award":["CFUG-965517"],"award-info":[{"award-number":["CFUG-965517"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,11,8]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The present study aimed to investigate if and how the panorama of acute cholecystitis changed in 2020 in Sweden. Seven aspects were identified, the incidence of cholecystitis, the Tokyo grade, the timing of diagnosis and treatment, the proportion treated with early surgery, the proportion of patients treated with delayed surgery, and new complications from gallstones.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective multicentre cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>3 hospitals in Sweden, covering 675\u2009000 inhabitants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1634 patients with cholecystitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>The incidence, treatment choice and diagnostic and treatment delay were investigated by comparing prepandemic and pandemic patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients diagnosed with cholecystitis during the pandemic were more comorbid (American Society of Anesthesiologists 2\u20135, 86% vs 81%, p=0.01) and more often had a diagnostic CT (67% vs 59%,\u2009p=0.01). There were variations in the number of patients corresponding with the pandemic waves, but there was no overall increase in the number of patients with cholecystitis (78 vs 76\u2009cases\/100 000 inhabitants, p=0.7) or the proportion of patients treated with surgery during the pandemic (50% vs 50%, p=0.4). There was no increase in time to admission from symptoms (both median 1\u2009day, p=0.7), or surgery from admission (both median 1\u2009day, p=0.9). The proportion of grades 2\u20133 cholecystitis was not higher during the pandemic (46% vs 44%,\u2009p=0.9). The median time to elective surgery increased (184 days vs 130 days, p=0.04), but there was no increase in new gallstone complications (35% vs 39%,\u2009p=0.3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Emergency surgery for cholecystitis was not impacted by the pandemic in Sweden. Patients were more comorbid but did not have more severe cholecystitis nor was there a delay in seeking care. Fewer patients non-operatively managed had elective surgery within 6 months of their initial diagnosis but there was no corresponding increase in gallstone complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-078407","type":"journal-article","created":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T09:15:42Z","timestamp":1701335742000},"page":"e078407","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Effect of the COVID-19 pandemic on the care for acute cholecystitis: a Swedish multicentre retrospective cohort study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1621-7872","authenticated-orcid":false,"given":"Erik","family":"Osterman","sequence":"first","affiliation":[{"name":"CKF G\u00e4vleborg, Uppsala University, G\u00e4vle, Sweden"},{"name":"Department of Surgery, G\u00e4vle Sjukhus, G\u00e4vle, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofia","family":"Jakobsson","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Uppsala University, Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Larsson","sequence":"additional","affiliation":[{"name":"Department of Surgery, G\u00e4vle Sjukhus, G\u00e4vle, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredrik","family":"Linder","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Uppsala University, Uppsala, Sweden"},{"name":"Department of Surgery, Uppsala University Hospital, Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,11,30]]},"reference":[{"key":"2025121511275031000_13.11.e078407.1","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jhbp.516","article-title":"Tokyo guidelines 2018: flowchart for the management of acute cholecystitis","volume":"25","author":"Okamoto","year":"2018","journal-title":"J Hepato Biliary Pancreat"},{"key":"2025121511275031000_13.11.e078407.2","unstructured":"American College of Surgeons . COVID-19: recommendations for management of elective surgical procedures. COVID-19 Recomm. Manag. elect. Surg. Proced. 2020. 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