Textbook outcome in urgent early cholecystectomy for acute calculous cholecystitis: results post hoc of the S.P.Ri.M.A.C.C study
Authors: Fugazzola Paola , Carbonell-Morote Silvia , Cobianchi Lorenzo , Coccolini Federico , Rubio-García Juan Jesús , Sartelli Massimo , Biffl Walter , Catena Fausto , Ansaloni Luca , Ramia Jose Manuel ,   the S.P.Ri.M.A.C.C. Collaborative Group, Morić Trpimir , Awad Selmy , Alzahrani Azzah M. , Elbahnasawy Mohamed , Massalou Damien , De Simone Belinda , Demetrashvili Zaza , Kimpizi Athina‑Despoina , Schizas Dimitrios , Balalis Dimitrios , Tasis Nikolaos , Papadoliopoulou Maria , Georgios Petrakis , Lasithiotakis Konstantinos , Ioannidis Orestis , Bains Lovenish , Magnoli Matteo , Cianci Pasquale , Conversano Nunzia Ivana , Pasculli Alessandro , Andreuccetti Jacopo , Arici Elisa , Pignata Giusto , Tiberio Guido A. M. , Podda Mauro , Murru Cristina , Veroux Massimiliano , Distefano Costanza , Centonze Danilo , Favi Francesco , Agnoletti Vanni , Bova Rafaele , Convertini Girolamo , Balla Andrea , Sasia Diego , Giraudo Giorgio , Gabriele Anania , Tartaglia Nicola , Pavone Giovanna , D’Acapito Fabrizio , Fabbri Nicolò , Ferrara Francesco , Cimbanassi Stefania , Ferrario Luca , Ciof Stefano , Ceresoli Marco , Fumagalli Chiara , Degrate Luca , Degiuli Maurizio , Sofa Silvia , Licari Leo , Tomasoni Matteo , Dominioni Tommaso , Farè Camilla Nikita , Maestri Marcello , Viganò Jacopo , Sargenti Benedetta , Anderloni Andrea , Musella Valeria , Frassini Simone , Gambini Giulia , Improta Mario , Patriti Alberto , Coletta Diego , Conti Luigi , Malerba Michele , Andrea Muratore , Calabrò Marcello , De Zolt Beatrice , Bellio Gabriele , Giordano Alessio , Luppi Davide , Corbellini Carlo , Sampietro Gianluca Matteo , Marafante Chiara , Rossi Stefano , Mingoli Andrea , Lapolla Pierfrancesco , Cicerchia Pierfranco M. , Siragusa Leandro , Grande Michele , Arcudi Claudio , Antonelli Amedeo , Vinci Danilo , De Martino Ciro , Armellino Mariano Fortunato , Bisogno Enrica , Visconti Diego , Santarelli Mauro , Montanari Elena , Biloslavo Alan , Germani Paola , Zaghi Claudia , Oka Naoki , Fathi Mohd Azem , Ríos‑Cruz Daniel , Hernandez Edgard Efren Lozada , Garzali Ibrahim Umar , Duarte Liliana , Negoi Ionut , Litvin Andrey , Chowdhury Sharfuddin , Alshahrani Salem M. , Carbonell‑Morote Silvia , Rubio‑Garcia Juan J. , Moreira Claudia Cristina Lopes , Ponce Iñigo Augusto , Mendoza‑Moreno Fernando , Campaña Anna Muñoz , Bayo Heura Llaquet , Serra Andrea Campos , Landaluce Aitor , Estraviz‑Mateos Begoña , Markinez‑Gordobil Izaskun , Serradilla‑Martín Mario , Paredero Antonio Cano‑ , Dobón‑Rascón Miguel Ángel , Hamid Hytham , Baraket Oussama , Gonullu Emre , Leventoglu Sezai , Turk Yilmaz , Büyükkasap Çağrı , Aday Ulaş , Kara Yasin , Kabuli Hamit Ahmet , Atici Semra Demirli , Colak Elif , Chooklin Serge , Chuklin Serhii , Ruta Federico , Di Martino Marcello , Mas Francesca Dal , Abu‑Zidan Fikri M. , Di Saverio Salomone , Leppäniemi Ari , Martín‑Pérez Elena , de la Hoz Rodríguez Ángela , Moore Ernest E. , Peitzman Andrew B. 
Published: March 2024

Abstract
Introduction
A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis.

Objetive
The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO.

Materials and methods
This is a post hoc study of the SPRiMACC study. It´s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC.

Outcomes
1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC.

Conclusion
Knowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome.