Clinical characteristics and management of acute cholecystitis after cardiovascular surgery.

BACKGROUND Acute cholecystitis (AC) is a severe complication after cardiovascular surgery (CS). The purpose of this study was to delineate the clinical picture of AC after CS to propose an optimal treatment strategy. METHODS We retrospectively reviewed the records of 88 patients who underwent cholecystectomy for grade II or III AC between 2008 and 2019 (AC after CS: Group CS, n=37; AC without CS: Group non-CS, n=51). RESULTS The proportion of grade III AC in Group CS was significantly higher than that in Group non-CS (73% vs. 41%, P=0.005). Furthermore, the incidences of acalculous (81% vs. 39%) and gangrenous (86% vs. 59%) AC were significantly higher in Group CS (P<0.05 for both). In Group CS, 11 patients had had percutaneous drainage preceding surgery, for whom cholecystectomy within 3 days was eventually necessary because their general condition was exacerbated. The incidence of a positive culture from the gallbladder bile and blood samples of Group CS were significantly higher (P<0.05 for both); multidrug-resistant bacteria were detected at an especially high rate. However, the morbidity rate was comparable and zero mortality was achieved in both groups. CONCLUSIONS Timely surgical intervention without hesitation is recommended for AC after CS.