Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)
Authors:   CHOLECOVID Collaborative, Spiers Harry V M , Kouli Omar , Ahmed Waheed U , Varley Rebecca , Ahari Daniel , Argus Leah , McLean Kenneth A , Kamarajah Sivesh K , Coe Peter , Griffiths Ewen A , Chan Anthony KC , Macutkiewicz Christian , Jamdar Saurabh , Wilson Michael , Fullwood Catherine , Toogood Giles , Siriwardena Ajith K , Kouli Omar , McLean Kenneth , Fullwood Catherine , Ahari Daniel , Argus Leah , Varley Rebecca , Spiers Harry V M , Kouli Omar , Ahmed Waheed , Gilchrist Andrew , Goldsworthy Matthew , Rashid Majid , Pockney P , Varela J , Brindl N , Ramirez J , Marafante C , Iwao Y , Ghzawi A , Elhadi M , Gacaferi H , Varghese C , Adeyeye A , Alser O , Teh C , Prieto M , Hasan A , Al-Naggar H , Salgado R , Veracierto F , Lancelotti T , Solinas D , Oddi R , Garcia FW , Mazza Diez E , Andrade Ramirez MR , Bracco R , Fernandez D , Maraschio MA , Obeide L , Giordano E , Alcaraz A , Marani MA , Aguirre N , Luna F , Francesconi M , Chiham F , Ramos Cossio R , Alvarez FA , Pantoja Pachajoa DA , Mandojana F , Merlo IG , Gonzalez MH , Cervelo G , Puma R , Vardaro GF , Davis A , Jurat D , Guenoff C , Raubenheimer K , Goddard K , Brown K , Wegrecki KJ , Cheung HYC , Yang M , Cheung H , Siddiqui J , Ahn JH , Huynh R , Lam YH , Afzal M , Ong BS , Chua MYM , Ly K , Thomson JE , Watson D , Dawson AC , Drane A , Van Ruyven S , Lun EWY , Pockney P , Ferguson M , Jeong JY , De Silva C , Wills V , Gundara J , Mccourt E , Bong C , Tabone R , Wong WJ , Gray A , Koh D , Pollock M , Singhal S , Smith R , Dudi-Venkata NN , Kanhere H , Stranz C , Seow W , Mansour LT , Wormald J , Loveday BPT , Thomson B , O’Donnell T , Milenkovski N , Herath M , Trochsler M , Farfus A , Maddern G , Bunjo Z , Kuan LL , Atanasov G , Dawson A , Drane A , van Ruyven S , Lun E , Samadov E , Namazov I , Asgarov M , Ibrahimli A , Srinivasan M , Saeed MF , Aljawder H , Juma I , Coimbra FJ , Marques N , Casteleins WA , Petruzziello A , Jabur G , Rodriguez JFP , Buso PL , MacKenzie S , Hsiao M , Sljivic I , Tecson A , Karanicolas PJ , Roke R , Moon J , Butler EV , Riquelme F , Yanez M , Catan F , Uribe M , Carriel F , Oppliger F , Paredes A , Daroch D , Aguayo JC , Perez Rivera CJ , Acosta Buitrago LM , Kadamani Abiyomaa A , Mosquera Paz MS , Cabrera P , Corso J , Ozcay N , Ozant A , Arslan K , Besim H , Almezghwi H , Azzam AY , Bessa S , El-Sayes I , Badawy A , Wael M , El-Gendi A , Azab MA , Fayed M , El Kassas M , Gamal M , Tawheed A , Al Shafie A , Emile S , Elfallal A , Elfeki H , Shalaby M , Sakr A , Elbahnasawy M , Shama M , Abdel-Elsalam W , Abd-Elsalam S , Escobar Dominguez JE , Medrano F , Gaitan S , Escalon Gonzalez OM , Alfaro Varela JC , Cea M , Interiano M , Cabrera B , Lakkis Z , Georges P , Antonot C , Magnin J , Kamphues C , Lauscher JC , Schineis C , Loch FN , Lee LD , Beyer K , Bouchagier K , Galanis I , Bartziotas D , Lostoridis E , Tourountzi P , Nagorni EA , Charalabopoulos A , Baili E , Kyros E , Vagios I , Skotsimara A , Liakakos T , Alexandrou A , Papalampros A , Papadopolous V , Tooulias A , Kentarchos I , Christou C , Tsoulfas G , Tale-Rosales LF , Lopez Muralles I , Melendez H , Bran G , Monroy Mahecha FA , Contreras JR , Porras DE , Paiz E , Soto ER , Ixcayau Hernandez JR , Gupta A , Rajput D , Kumar N , Mani R , Kant R , Sonkar AA , Anand A , Agrawal MK , Gaurav K , Tripathi M , Sikora S , Bharathy K , Kumar Rangapa M , Khuller DS , K SK , Bhojwwani R , Ayyar S , Jain N , Mehraj A , Hussain F , Nazir I , Shah M , Chowdri NA , Hilmi A , Argenio G , Atelli P , Palladino E , Armellino MF , Tamini N , Nespoli LC , Degrate L , Angrisani M , Carissimi F , Bordoni P , Fleres F , Bordoni P , Clarizia G , Spolini A , Franzini M , Cucinotta E , Badessi G , Mazzeo C , Viscosi F , Pintabona G , Campagnaro T , Poletto E , Turri G , Ruzzenente A , Conci S , Guglielmi A , Feo C , Fabbri N , Fazzin M , Giaccari S , Feo CV , Massani M , Pelizzo P , Colella M , Tutino R , Cappellacci F , Medas F , Canu GL , Erdas E , Calò PG , Porcu A , Perra T , Scanu AM , Feo CF , Fancellu A , Germani P , Giunta C , Biloslavo A , Abdallah H , Aizza G , Barberis A , Belli F , Santoliquido M , Filauro M , Canonico G , Nelli T , Di Martino C , Capezzuoli L , Anastasi A , Bressan L , Cortinovis S , Nagliati C , Colombo F , Ferrario L , Bondurri A , Guerci C , Maffioli A , Catena F , Perrone G , Giuffrida M , Morini A , Annicchiarico A , Gallo G , Carpino A , Ferrari F , De Paola G , Sammarco G , Callari C , Licari L , Sorce V , Di Miceli D , Lovisetto F , Zonta S , Lovisetto F , Chessa A , Fiorini A , De Manzoni Garberini A , Angelini E , Marafante C , Moggia E , Murgese A , Mungo S , Birolo SL , Garino M , Pipitone Federico NS , Muratore A , Lunghi EG , Calabro M , Cianci P , Enrico R , Capuzzolo S , Cafagna L , Minafra M , Sasia D , Gattolin A , Migliore M , Rimonda R , Travaglio E , De Marco G , Elter C , Bargellini T , D’amico S , Zambonin D , Caponi A , Calini G , Puggioni A , Bresadola V , Zalla T , Cantafio S , Feroci F , Romoli L , Giudicissi R , Picciariello A , Papagni V , Dibra R , Picciariello A , Altomare DF , Pinotti E , Montuori M , Baronio G , Tonini V , Sartarelli L , Gori A , Cervellera M , Lapolla P , Sapienza P , Brachini G , Cirillo B , Zambon M , Mingoli A , Pascariello A , Boccia L , Benedetti S , Mantovani G , De Angelis M , Ferrara F , Testa V , Borghi F , Maione F , Pruiti Ciarello V , Giraudo G , Agresta F , Cestaro G , Prando D , Cavallo F , Zese M , Cillara N , Sechi R , Cardia R , Cannavera A , Putzu G , Frongia F , Pisanu A , Delogu D , Esposito G , Podda M , Iossa A , De Angelis F , Boru C , Silecchia G. , Palini GM , Garulli G , Veneroni S , Tammaro P , Maida P , Leake PA , Wanliss MG , Iwao Y , Sato K , Chiyonobu N , Imamura H , Yamazaki S , Watanabe M , Qasem A , Ayasra F , Al Dahabrh S , Khaled A , Alsaafin S , Al-Thunaibat A , Olaywah D , Alqudah S , Alqawasmi S , Khamees A , Guboug A , Es Salim M , Althwabteh T , Bani Khaled H , El-Hammuri N , Aljesrawi A , Alamaadany F , Eljareh M , Al Gasi AEJ , Alsaeiti S , Alkhafeefi AS , Suliaman T , Alanasri AHA , Haroun ABA , Haron A , Kilani AI , Ahmed M , Alawami M , Alawami A , Albashri M , Abusannuga M , Malek A , Jwaili N , Aldenfria A , Jwaili N , Elzwawi F , Almugaddami A , Egdeer ASA , Masoud M , Alazzabi B , Alezabi B , Shuwayyah A , Alkamkhe AAS , Aboulqasim I , Atiyah H , Alfagi RAA , Abdulmula A , Bouhuwaish A , Samer A , Salim R , Aboazamazem H , Almiqlash B , Biala M , Alganimi W , Ghamgh R , Ben Omar N , Alsoufi A , Aldreawi M , Saleim N , Sowan F , Saleem H , Ahmed Aqueelah , Samalavicius NE , Aliosin O , Dailidenas S , Dulskas A , Buckus B , Kuliesius Z , Bradunaite R , Dominguez-Rosado I , Buerba GA , Posadas-Trujillo OE , Alfaro-Goldaracena A , Cortes R , Mercado MA , Beristain-Hernandez JL , Mora-Munoz VS , Mena-Bedolla JM , Palacios Ramirez AR , Astorga Medina MM , Van Aert G , Ombashi S , Spillenaar Bilgen R , Vos D , Besselink M , Alberts V , Busch O , Bemelman W , Boermeester M , Daams F , Gordinou De Gouberville M , Van Duijvendijk P , De Graaff M , Baaij J , Gans S , Bos K , Goudsmit B , Den Dekker B , Braat A , Kuijpers A , Breukers S , Borel Rinkes I , Andel D , Hayes T , Carson D , Bhat S , van der Have J , Anderson C , Bissett I , Windsor J , Elliott BM , Scowcroft H , Mclauchlan J , Ritchie D , Jeffery F , Connor S , Xu W , Varghese C , Mashlan H , Thirayan V , Ly J , Mcguinness MJ , Ferguson L , Watt I , Harmston C , Akinmade A , Adeyeye A , Enoch E , Kayode-Nissi V , Ogundele I , Ayoade BA , Adekoya A , Nwokoro C , Opadeyi A , Adeyeye A , Yusuf A , Ojajuni A , Adepoju O , Muhammad Dauda Maigatari , Keffi Mubarak Musa , lawal Khalid , Muhammad Daniyan , Salonga D , Sael NA , Rey CM , Pestano M , Tan D , Bangayan NR , Sy DK , Ang D , Bernardo E , Chua JP , Alharthi M , Bukhari W , Bakier Mohammed K , Al Athath S , Ghunaim M , Saiedi H , Sultan N , Farsi A , Basendowah M , Alharthi M , Ghunaim M , Malibary N , Jaloun H , Altalhi Db , Organjee A , Moamena M , Al Zaidi TM , Alyami M , Alqannas M , Al-Urfan M , Elawad A , Alawadhi A , Alalawi Y , Alqarni A , Alqahtani B , Alayed A , Alsobaie K , Adi H , Malibary N , Elhaj M , Dehlawi A , Behairy G , Khaled I , Kmezic S , Radenkovic D , Aleksic L , Markovic V , Pejovic I , Antic A , Kalkan M , Vujanovic Gadjanski O , Dusan S , Marčetić B , Thiruchelvam N , Chiow AKH , Lee LS , Mun DYC , Tan EK , Koh YX , Loh WL , Wang Z , Chan CY , Kloppers C , Almgla N , Bernon M , Kahn M , Karimbocus N , Roldan Villavicencio JI , Goitia V , Gutierrez Rios RD , Garcia Ruiz S , Lopez Deogracias M , Turrado-Rodriguez V , Morales X , Hessheimer A , Termes Serra R , Beltran De Heredia J , Trujillo-Diaz J , Herreros-Rodríguez J , Montes-Manrique M , De Andres-Asenjo B , Beltrán-Heredia J , Gimenez Maurel T , Utrilla Fornals A , Martin Anoro LF , Cortese S , Perez Diaz MD , Ballón M , Morote M , Cebolla Rojas L , Oliver Guillen JR , Lopez De Fernandez A , Del Campo Lavilla M , Mora-Guzmán I , Escartin A , Pinillos A , Vela Polanco FF , Jara Quezada JH , Muriel Alvarez P , Tur-Martinez J , Camps J , Herrero E , Garcia-Domingo MI , Cugat Andorra E , Crespi Mir A , Claramonte Bellmunt O , Vicens Arbona JC , Fernandez Burgos IR , Prieto M , Sarriugarte Lasarte A , Marin H , Tellaeche De La Iglesia M , Ocerin Alganza O , Salinas Gomez J , Ramos-Martin P , Urbieta A , Nasimi Sabbagh R , Castell Gomez JT , Serrablo A , Paterna -Lopez S , Gutiérrez-Díez M , Abadía-Forcen MT , Serradilla-Martín M , Duran Muñoz-Cruzado VM , Pareja Ciuro F , Perea Del Pozo E , Aparicio Sanchez D , Dios-Barbeito S , Marenco De La Cuadra B , Retamar Gentil M , Reguera-Rosal J , Infantes Ormad M , Lopez-Ruiz JA , Landaluce-Olavarria A , Zevallos-Quiroz JC , Barrutia Leonardo J , Emaldi A , Begona E , Balciscueta Coltell I , Sebastian M , Martinez Ramos S , Martinez Alcaide S , Lorenzo Perez J , Martinez Insfran LA , Lopez-Morales P , Gimenez Frances C , Rahy-Martin A , Pelloni M , Ortiz-Lopez D , Benet-Muñoz O , Pinero-Gonzalez L , Alconchel F , Nicolas-Lopez T , Rodrigues K , Cascales Campos PA , Gomez-Bosch F , Ramirez Romero P , Ibrahim M , Hamid HKS , Idres R , Idris M , Mohammed O , Ayran S , Sinan AH , Kouli O , Ozben V , Aytac E , Aliyeva Z , Mutlu AU , Bilgin IA , Karahasanoglu T , Hamzaoglu I , Bozkirli B , Uprak TK , Kotan T , Coskun M , Kara Y , Somuncu E , Kocatas A , Bozkurt MA , Demirli Atici S , Kaya T , Sert I , Emiroglu M , Jaffar M , Younis MU , Aziz T , Ikram F , Sandal M , Al Madhloum Al Suwaidi F , Alshaikh MO , Saber A , Khammas A , Nessa A , Jardine R , Nicol L , Clark C , Mcgee A , Alkari B , Feretis M , Antakia R , Georgiades F , Moneim J , O’Neill R , Balakrishnan A , Lunevicius R , Sud A , Moutsos I , Gomez D , Shahid S , Majeed T , Ibrahim WKG , Kadum K , Melia R , Magee C , Chicken DW , Kumar S , Alshibshoubi M , van Laarhoven S , Dewi F , Williams J , Byrne B , Wilkerson P , Tang CB , Farhangmehr N , Jonas A , Charavanamuttu V , Almeida K , Efthimiou E , Boardley J , White A , Butt MA , Menzies D , Gundkalli Z , Hassanzadeh-Baboli D , Jones O , Mistry P , Saha S , Gerrard A , Evans J , Rajeev S , Ali W , Ross E , Gilliam A , Hitchins C , Emslie K , Spellar K , Sked H , Briggs C , Brown L , A Hemadasa N , Apollos JR , Belgaumkar A , Tawfik A , Brewin L , Oyewole B , Wadhawan H , Massie E , Rutherford D , Mcgivern K , Mcelroy L , De’Ath HD , Tobbal M , Nagendram S , Patel P , Handa S , Houghton G , Sundaralingam SS , Parker J , Morgan R , Gala T , Ibrahim S , Harby R , Abdelkarim M , Holroyd D , Carson D , Thomas R , Mclennan E , Boardley R , Jamieson NB , Ebied H , Gossage J , Davies A , Wheatstone S , Jawad Z , Jiao L , Rajagopal P , Sodergren M , Lami M , Gacaferi H , Wiberg A , Bond-Smith G , Gemmill E , Lenzi E , Sapre D , Herrod P , Boyd-Carson H , Garcea G , Issa E , Jackson A , Fashina T , Pan H , Farquharson B , Shafiq H , Emanuel O , Mahdi S , Jeyarajah S , Finch L , Whiting G , Pigott L , Martin J , Siriwardena AK , Beatson K , Abawi L , Lam W , Rea W , Andrews B , Al-Sarireh B , Soliman F , Burridge J , Jenvey C , Hammoda M , Hollyman M , Merker L , Richards J , Sukumaran V , Rogers S , Payne C , Bibi S , Raza K , Ul Ain N , Dronamraju S , Patil S , Nachimuthu S , Ravindran S , Patel S , Ivanov B , Patel M , Ejtehadi F , Jebamani J , Akhter Rahman MM , Woodun H , De Prendergast A , Afzal A , Bota E , Gupta A , Abdul SR , Karmarkar R , Crockett E , Evans L , Appleton B , Griffiths E , Dada O , Kulkarni R , Albirnawi H , Gravestock P , Vincenti C , Taribagil S , Dent B , Tse C , Clayton B , Burdekin E , Bannister L , Alam I , Gray J , Mactier M , Pollock A , Gough V , Kanchustambam SR , Ridgway M , Arujunan K , Gopalswamy S , Monteiro De Barros J , Lyons T , Griffith D , Awan AK , Latif J , Bandlamudi N , Bhatti I , Raptis DA , Machairas N , Pissanou T , Mestre-Costa J , Hidalgo Salinas C , Pollok JM , Al-Ardah M , White A , Watson-Jones E , Rontree-Carey T , Boyce T , Hawkin P , Elmaradny A , Ross K , Adu-Peprah E , Pinto K , Dunne D , Mccready R , Nita G , Szatmary P , Tay VL , Rajput K , Rajendran I , Chaudhury M , Zambas G , Swaminathan C , Atif QAA , Barrow T , Williams O , Malik A , Conroy S , Lindley S , Gilmore K , Boden E , Richards SK , Hraishawi I , Polak P , Mclaughlin D , Deeny D , Shuttleworth R , Harris A , Peilober-Richardson A , Morris GC , Sara X , Almourad H , Ang Y , Smyth R , Ding D , Foster J , Bond A , Kumar Y , Ahmad A , Radoi D , Alkaili-Alyamani A , Balakrishnan S , Satchidanand RY , Danwaththa Liyanage AS , Blake I , Ransome M , Weerasinghe C , Kenington C , Mayo K , Mohammed M , Cockbain AJ , Peckham-Cooper A , Mccauley G , Gordon C , Smith A , Hawkins W , Chakravartty S , Baillie C , Kenny R , Kumar A , Koimtzis G , Bellamy E , Menon A , Kanakala A , Nevins EJ , Madhavan A , Thulasiraman S , France K , O’Connor A , Idama D , Raslan C , Sridhar S , Parveen M , Mubashar T , Jarvis S , Cakmak I , Wright C , Andrews S , Abdelsaid K Abdul Aal Y , Jayasankar B , Morilla J , Shehata M , Subba N , Tewari N , El-Sayed C , Somaie D , Beheiry N , Douka E , Arumugam S , Wijetunga I , Leivers E , Ibrahim B , Khan K , Wheat J , Christopher J , Barnett R , Elberm H , Booker J , Ashai S , Berry D , Luhmann A , Sgro A , Rashid MM , Galea M , Jeyakumar J , Marriott P , Zafar S , Baker A , Yershov D , Galanopoulos G , Gupta A , Jordan R , Peinado Garcia C , Anyaugo N , Bath MF , Evans J , Omatseye J , Roberts L , Argyriou EO , Machesney M , Parmar C , Clark S , Khalil H , Unsworth S , Mlotshwa M , Ayoub N , Aboelkhair A , Iosif E , Mohamed N , Reynolds E , Mackender E , Robinson D , Mufti W , Fischkoff K , Coleman N , Anantha Sathyanarayana S , Deutsch G , Giangola M , Lin D , Weiss M , Chung C , Nguyen A , Mueller J , Dabit M , Gordon J , McGuire E , Rashid O , Georgi E , Gallo M , Kunstman JW , Peters NV , O’Connor R , Bhattacharya B , Onkendi E , Santos AP , Richmond R , Warren M , Zhang K , Broderick R , Clary B , Horgan S , Doucet J , Liepert A , Harmon L , McCall C , Sham JG , Williams E , Labadie KP , Clark NM , Dickerson LK , Hammill CW , Williams G , Kushner B , Cos H , Zarate Rodriguez J , Bailey K , Al-Raimi IMN , Al-Zazay K , Ahmed Mohammed Al-Mahdi S , Mohammed Aldowbli S , Al-Shehari M , Shream S , Al-Ameri S , Aeed M , Al-Naggar H , Aldawbali M , Alsayadi R , Alsayadi M 
Published: March 2022

Background

This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.

Methods

CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality.

Results

This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121).

Conclusion

CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic.