{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T13:11:42Z","timestamp":1768914702346,"version":"3.49.0"},"reference-count":14,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2019,6,20]]},"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Acute cholecystitis presents in a spectrum of severity, where acute disease may be complicated by severe inflammation, gangrene, and perforation. The goal of this study is to outline an evidence-based grading scale that predicts patient outcomes after laparoscopic cholecystectomy (LC).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective review of all patients with a preoperative diagnosis of acute cholecystitis who underwent LC from August 2011 until June 2015 at a tertiary-level hospital was performed. Patients who underwent elective cholecystectomy, incidental cholecystectomy, a planned open cholecystectomy, had gallstone pancreatitis or choledocholithiasis, and those admitted to a non-surgical service were excluded. Severity of disease was obtained from operative and pathology reports, and patients were classified according to the following grading scale:<\/jats:p>\n                  <jats:p>Grade I: symptomatic cholelithiasis.<\/jats:p>\n                  <jats:p>Grade II: acute\/chronic cholecystitis.<\/jats:p>\n                  <jats:p>Grade III: gangrenous\/necrotizing cholecystitis.<\/jats:p>\n                  <jats:p>Grade IV: gallbladder perforation or abscess.<\/jats:p>\n                  <jats:p>The groups were compared on age, gender, body mass index, severity of gallbladder disease, presence of preoperative systemic inflammatory response syndrome, hospital length of stay, length of operation, complications within 30 days, conversion to open rate, and cost of hospitalization.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>During the study period, 1252 patients who underwent laparoscopic cholecystectomy were analyzed; 677 met inclusion criteria. The most common grade was grade 2, which was present in 80% of patients, followed by grade 3, which was found in 16% of patients. Grade 4 cholecystitis occurred in 1.2% of patients and grade 1 occurred in 3.2% of patients. There were statistically significant increases in age, presence of preoperative systemic inflammatory response syndrome, hospital length of stay, conversion to open rate, cost of hospitalization, and length of operation with increased cholecystitis grade.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The proposed grading scale is an accurate predictor of duration of operation, conversion to open rate, hospital length of stay, and cost of hospitalization.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>III<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Study type<\/jats:title>\n                  <jats:p>Prognostic<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2019-000324","type":"journal-article","created":{"date-parts":[[2019,7,12]],"date-time":"2019-07-12T05:34:28Z","timestamp":1562909668000},"page":"e000324","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["A predictive grading scale for acute cholecystitis"],"prefix":"10.1136","volume":"4","author":[{"given":"Sammy","family":"Siada","sequence":"first","affiliation":[{"name":"Department of Surgery, University of California San Francisco Fresno Center for Medical Education and Research, Fresno, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Jeffcoach","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Francisco Fresno Center for Medical Education and Research, Fresno, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel C","family":"Dirks","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Francisco Fresno Center for Medical Education and Research, Fresno, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary M","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Francisco Fresno Center for Medical Education and Research, Fresno, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy M","family":"Kwok","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Francisco Fresno Center for Medical Education and Research, Fresno, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence P","family":"Sue","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Francisco Fresno Center for Medical Education and Research, Fresno, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James W","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Francisco Fresno Center for Medical Education and Research, Fresno, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,7,11]]},"reference":[{"key":"2025081711081458000_4.1.e000324.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-006-1159-4"},{"key":"2025081711081458000_4.1.e000324.2","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s00534-012-0568-9","article-title":"TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos)","volume":"20","author":"Yokoe","year":"2013","journal-title":"J Hepatobiliary Pancreat 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Surg"},{"key":"2025081711081458000_4.1.e000324.8","doi-asserted-by":"publisher","DOI":"10.1378\/chest.101.6.1644"},{"key":"2025081711081458000_4.1.e000324.9","doi-asserted-by":"publisher","DOI":"10.1007\/BF01658790"},{"key":"2025081711081458000_4.1.e000324.10","doi-asserted-by":"crossref","unstructured":"Gurusamy KS , Samraj K . Early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Cochrane Database Syst Rev 2006.","DOI":"10.1002\/14651858.CD005440.pub2"},{"key":"2025081711081458000_4.1.e000324.11","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800621025"},{"key":"2025081711081458000_4.1.e000324.12","doi-asserted-by":"crossref","first-page":"167-73","DOI":"10.1097\/TA.0b013e3182788b71","article-title":"No need to wait: an analysis of the timing of cholecystectomy during admission for acute cholecystitis using the American College of Surgeons National Surgical Quality Improvement Program database","volume":"74","author":"Brooks","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"key":"2025081711081458000_4.1.e000324.13","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3182a1599b"},{"key":"2025081711081458000_4.1.e000324.14","doi-asserted-by":"crossref","unstructured":"Gurusamy KS , Davidson C , Gluud C , Davidson BR . Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. 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