Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304)
Acute cholecystitis is a common disease, and laparoscopic surgery is the standard of care. Optimal timing of surgery for acute cholecystitis remains controversial: either early surgery shortly after hospital admission or delayed elective surgery after a conservative treatment with antibiotics. The A...
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| Vydáno v: | Annals of surgery Ročník 258; číslo 3; s. 385 |
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| Hlavní autoři: | , , , , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
United States
01.09.2013
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| Témata: | |
| ISSN: | 1528-1140, 1528-1140 |
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| Abstract | Acute cholecystitis is a common disease, and laparoscopic surgery is the standard of care.
Optimal timing of surgery for acute cholecystitis remains controversial: either early surgery shortly after hospital admission or delayed elective surgery after a conservative treatment with antibiotics.
The ACDC ("Acute Cholecystitis-early laparoscopic surgery versus antibiotic therapy and Delayed elective Cholecystectomy") study is a randomized, prospective, open-label, parallel group trial. Patients were randomly assigned to receive immediate surgery within 24 hours of hospital admission (group ILC) or initial antibiotic treatment, followed by delayed laparoscopic cholecystectomy at days 7 to 45 (group DLC). For infection, all patients were treated with moxifloxacin for at least 48 hours. Primary endpoint was occurrence of predefined relevant morbidity within 75 days. Secondary endpoints were as follows: (1) 75-day morbidity using a scoring system; (2) conversion rate; (3) change of antibiotic therapy; (4) mortality; (5) costs; and (6) length of hospital stay.
Morbidity rate was significantly lower in group ILC (304 patients) than in group DLC (314 patients): 11.8% versus 34.4%. Conversion rate to open surgery and mortality did not differ significantly between groups. Mean length of hospital stay (5.4 days vs 10.0 days; P < 0.001) and total hospital costs (€2919 vs €4262; P < 0.001) were significantly lower in group ILC.
In this large, randomized trial, laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs. Therefore, we believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients. (NCT00447304). |
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| AbstractList | Acute cholecystitis is a common disease, and laparoscopic surgery is the standard of care.
Optimal timing of surgery for acute cholecystitis remains controversial: either early surgery shortly after hospital admission or delayed elective surgery after a conservative treatment with antibiotics.
The ACDC ("Acute Cholecystitis-early laparoscopic surgery versus antibiotic therapy and Delayed elective Cholecystectomy") study is a randomized, prospective, open-label, parallel group trial. Patients were randomly assigned to receive immediate surgery within 24 hours of hospital admission (group ILC) or initial antibiotic treatment, followed by delayed laparoscopic cholecystectomy at days 7 to 45 (group DLC). For infection, all patients were treated with moxifloxacin for at least 48 hours. Primary endpoint was occurrence of predefined relevant morbidity within 75 days. Secondary endpoints were as follows: (1) 75-day morbidity using a scoring system; (2) conversion rate; (3) change of antibiotic therapy; (4) mortality; (5) costs; and (6) length of hospital stay.
Morbidity rate was significantly lower in group ILC (304 patients) than in group DLC (314 patients): 11.8% versus 34.4%. Conversion rate to open surgery and mortality did not differ significantly between groups. Mean length of hospital stay (5.4 days vs 10.0 days; P < 0.001) and total hospital costs (€2919 vs €4262; P < 0.001) were significantly lower in group ILC.
In this large, randomized trial, laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs. Therefore, we believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients. (NCT00447304). Acute cholecystitis is a common disease, and laparoscopic surgery is the standard of care.OBJECTIVEAcute cholecystitis is a common disease, and laparoscopic surgery is the standard of care.Optimal timing of surgery for acute cholecystitis remains controversial: either early surgery shortly after hospital admission or delayed elective surgery after a conservative treatment with antibiotics.BACKGROUNDOptimal timing of surgery for acute cholecystitis remains controversial: either early surgery shortly after hospital admission or delayed elective surgery after a conservative treatment with antibiotics.The ACDC ("Acute Cholecystitis-early laparoscopic surgery versus antibiotic therapy and Delayed elective Cholecystectomy") study is a randomized, prospective, open-label, parallel group trial. Patients were randomly assigned to receive immediate surgery within 24 hours of hospital admission (group ILC) or initial antibiotic treatment, followed by delayed laparoscopic cholecystectomy at days 7 to 45 (group DLC). For infection, all patients were treated with moxifloxacin for at least 48 hours. Primary endpoint was occurrence of predefined relevant morbidity within 75 days. Secondary endpoints were as follows: (1) 75-day morbidity using a scoring system; (2) conversion rate; (3) change of antibiotic therapy; (4) mortality; (5) costs; and (6) length of hospital stay.METHODSThe ACDC ("Acute Cholecystitis-early laparoscopic surgery versus antibiotic therapy and Delayed elective Cholecystectomy") study is a randomized, prospective, open-label, parallel group trial. Patients were randomly assigned to receive immediate surgery within 24 hours of hospital admission (group ILC) or initial antibiotic treatment, followed by delayed laparoscopic cholecystectomy at days 7 to 45 (group DLC). For infection, all patients were treated with moxifloxacin for at least 48 hours. Primary endpoint was occurrence of predefined relevant morbidity within 75 days. Secondary endpoints were as follows: (1) 75-day morbidity using a scoring system; (2) conversion rate; (3) change of antibiotic therapy; (4) mortality; (5) costs; and (6) length of hospital stay.Morbidity rate was significantly lower in group ILC (304 patients) than in group DLC (314 patients): 11.8% versus 34.4%. Conversion rate to open surgery and mortality did not differ significantly between groups. Mean length of hospital stay (5.4 days vs 10.0 days; P < 0.001) and total hospital costs (€2919 vs €4262; P < 0.001) were significantly lower in group ILC.RESULTSMorbidity rate was significantly lower in group ILC (304 patients) than in group DLC (314 patients): 11.8% versus 34.4%. Conversion rate to open surgery and mortality did not differ significantly between groups. Mean length of hospital stay (5.4 days vs 10.0 days; P < 0.001) and total hospital costs (€2919 vs €4262; P < 0.001) were significantly lower in group ILC.In this large, randomized trial, laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs. Therefore, we believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients. (NCT00447304).CONCLUSIONSIn this large, randomized trial, laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs. Therefore, we believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients. (NCT00447304). |
| Author | Stremmel, Wolfgang Büchler, Markus W Klar, Ernst Daniel, Dietmar Schön, Michael R Gutt, Carsten N Baron, Alexandra Weigand, Kilian Schunter, Oliver Seitz, Helmut K Encke, Jens Ackmann, Sven Harnoss, Julian-Camill Golling, Markus T Köninger, Jörg Zoller, Wolfram G Kipfmüller, Karl Menges, Markus Ridwelski, Karsten Feilhauer, Katharina Götze, Thorsten |
| Author_xml | – sequence: 1 givenname: Carsten N surname: Gutt fullname: Gutt, Carsten N organization: Departments of Surgery and †Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany ‡Department of Surgery, Katharinen Hospital, Stuttgart, Germany; §Department of Surgery, St. Marien Hospital Muelheim, Muelheim ¶Department of Surgery, Bietigheim Hospital, Bietigheim-Bissingen, Germany ‖Department of Surgery, Ketteler Hospital, Offenbach, Germany; Departments of Surgery I and ††Internal Medicine II, Diakonie Hospital, Schwaebisch Hall, Germany ‡‡Department of Surgery, Rostock University Hospital, Germany §§Department of Internal Medicine, Katharinen Hospital, Stuttgart, Germany; Departments of ¶¶Surgery and ‖‖Gastroenterology, Magdeburg Hospital, Magdeburg, Germany Department of Surgery, Bad Cannstatt Hospital, Stuttgart, Germany †††Karlsruhe Hospital, Karlsruhe, Germany; Department of ‡‡‡Internal Medicine, Salem Hospital, Heidelberg, Germany §§§Research and Public Relations, Burscheid, Germany ¶¶¶Department of Surgery, Salem Hospital, Heidelberg, Germany – sequence: 2 givenname: Jens surname: Encke fullname: Encke, Jens – sequence: 3 givenname: Jörg surname: Köninger fullname: Köninger, Jörg – sequence: 4 givenname: Julian-Camill surname: Harnoss fullname: Harnoss, Julian-Camill – sequence: 5 givenname: Kilian surname: Weigand fullname: Weigand, Kilian – sequence: 6 givenname: Karl surname: Kipfmüller fullname: Kipfmüller, Karl – sequence: 7 givenname: Oliver surname: Schunter fullname: Schunter, Oliver – sequence: 8 givenname: Thorsten surname: Götze fullname: Götze, Thorsten – sequence: 9 givenname: Markus T surname: Golling fullname: Golling, Markus T – sequence: 10 givenname: Markus surname: Menges fullname: Menges, Markus – sequence: 11 givenname: Ernst surname: Klar fullname: Klar, Ernst – sequence: 12 givenname: Katharina surname: Feilhauer fullname: Feilhauer, Katharina – sequence: 13 givenname: Wolfram G surname: Zoller fullname: Zoller, Wolfram G – sequence: 14 givenname: Karsten surname: Ridwelski fullname: Ridwelski, Karsten – sequence: 15 givenname: Sven surname: Ackmann fullname: Ackmann, Sven – sequence: 16 givenname: Alexandra surname: Baron fullname: Baron, Alexandra – sequence: 17 givenname: Michael R surname: Schön fullname: Schön, Michael R – sequence: 18 givenname: Helmut K surname: Seitz fullname: Seitz, Helmut K – sequence: 19 givenname: Dietmar surname: Daniel fullname: Daniel, Dietmar – sequence: 20 givenname: Wolfgang surname: Stremmel fullname: Stremmel, Wolfgang – sequence: 21 givenname: Markus W surname: Büchler fullname: Büchler, Markus W |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24022431$$D View this record in MEDLINE/PubMed |
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| PublicationTitle | Annals of surgery |
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| References | 24979596 - Ann Surg. 2015 Aug;262(2):e74 24670847 - Ann Surg. 2015 Aug;262(2):e87 24441795 - Ann Surg. 2015 Aug;262(2):e63-4 28266993 - Ann Surg. 2017 Apr;265(4):e53-e54 26167723 - Ann Surg. 2015 Aug;262(2):e87 24509199 - Ann Surg. 2015 Aug;262(2):e63-4 |
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| Snippet | Acute cholecystitis is a common disease, and laparoscopic surgery is the standard of care.
Optimal timing of surgery for acute cholecystitis remains... Acute cholecystitis is a common disease, and laparoscopic surgery is the standard of care.OBJECTIVEAcute cholecystitis is a common disease, and laparoscopic... |
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| SubjectTerms | Adult Aged Anti-Bacterial Agents - economics Anti-Bacterial Agents - therapeutic use Aza Compounds - economics Aza Compounds - therapeutic use Cholecystectomy, Laparoscopic - economics Cholecystectomy, Laparoscopic - methods Cholecystitis, Acute - drug therapy Cholecystitis, Acute - economics Cholecystitis, Acute - mortality Cholecystitis, Acute - surgery Combined Modality Therapy Conversion to Open Surgery - statistics & numerical data Cost-Benefit Analysis Drug Administration Schedule Female Fluoroquinolones Germany Hospital Costs - statistics & numerical data Humans Intention to Treat Analysis Length of Stay - economics Length of Stay - statistics & numerical data Male Middle Aged Postoperative Complications - epidemiology Prospective Studies Quinolines - economics Quinolines - therapeutic use Slovenia Time Factors Treatment Outcome |
| Title | Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304) |
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