Risk Factors for Acute Cholecystitis and a Complicated Clinical Course in Patients With Symptomatic Cholelithiasis

Background: We prospectively evaluated the risk factors for acute cholecystitis (AC). Design: Prospective study. Setting: Department of surgery at a university hospital. Patients: From July 2004 through December 2007, the data of 1059 patients who underwent laparoscopic cholecystectomy for symptomatic gallstones were prospectively recorded. The relationships between the clinical outcomes and the patients' demographic factors and comorbidities were analyzed by performing multivariate analyses. Main Outcome Measures: Risk factors for AC and operative outcome. Results: The diagnoses of the 1059 patients who underwent laparoscopic cholecystectomy were chronic cholecystitis (n=704 [66.5%]) and AC (n=355; [33.5%]). An age older than 60 years (odds ratio [OR], 1.955; 95% confidence interval [CI], 1.441-2.652), male sex (OR, 1.769; 95% CI, 1.346-2.325), the presence of cardiovascular disease (OR, 1.826; 95% CI, 1.325-2.517), the presence of diabetes mellitus (OR, 1.802; 95% CI, 1.153-2.816), and a history of cerebrovascular accident (ischemic stroke or cerebral hemorrhage) (OR, 8.107; 95% CI, 2.650-24.804) were identified as independent risk factors for AC after multivariate analysis. Approximately 85% of the patients with a history of cerebrovascular accident presented with AC (P < .001), 54.5% of whom experienced complicated AC (P < .001). Acute cholecystitis was associated with greater operative difficulty and more postoperative morbidity than chronic cholecystitis. Conclusion: For the patients with risk factors for AC, early cholecystectomy is recommended before the disease progresses to AC.