COMPARATIVE ANALYSIS OF CLINICAL PRESENTATION AND INTRAOPERATIVE FINDINGS OF ACUTE CHOLECYSTITIS IN DIABETIC AND NON-DIABETIC PATIENTS

Abstract

Objective: To compare clinical presentation and predefined intraoperative findings of acute calculous cholecystitis between diabetic and non-diabetic patients.

Study Design: Prospective comparative cross-sectional study.

Setting: Department of General Surgery, Dr Ziauddin University Hospital, Karachi.

Period: Four months.

Material & Methods: One hundred and sixteen patients were involved in the study. Purposive non-random sampling was used, resulting in 58 diabetic patients and 58 without diabetes as the comparison group. Data capture was done in a standardized manner for the clinic, laboratory, imaging, and intraoperative data. Depending on the variables, either Chi-square, Fisher’s exact test, t-test, or the Mann-Whitney U test was used for the analysis. Some of the outcomes were subjected to analysis using the multivariable logistic regression model.

Results: Significance was observed in a number of the outcomes for diabetic and non-diabetic patients. Results from the analysis of the intraoperative findings for the patients who were diabetic were as follows: diabetic patients were older, had higher WBC and CRP levels than their non-diabetic counterparts, and had symptoms that persisted for over 72 hours. Several adverse intraoperative findings were more significant for diabetic patients. For example, dense pericholecystic adhesion was found in 63.8% of diabetic patients compared to just 36.2% of non-diabetic patients (p = 0.003). Additionally, 39.7% of diabetic patients had a contracted/fibrotic gallbladder versus just 15.5% of non-diabetic patients (p = 0.004). Difficult dissection of Calot’s was also more significant for diabetic patients, where it was observed in 58.6% of diabetic patients, compared to 34.5% of non-diabetic patients (p = 0.009). The greatest difference was that the operative time was greater than 90 minutes for 77.6% of diabetic patients, compared to 34.5% of non-diabetic patients (p < 0.001). After the adjustments, the findings of the analysis demonstrated that diabetes was an important factor for difficult dissection of Calot’s (aOR = 2.89; 95% CI 1.12 - 7.51) and operative time greater than 90 minutes (aOR = 6.14; 95% CI 2.21 - 17.05).

Conclusion: The analysis indicates a pattern of increased operative complexity in the presence of diabetes. These findings are numerical and are not clinical evidence and should be supported with findings of real patients before publication