Ulus Travma Acil Cerrahi Derg. 2024; 30(12): 883-891 | DOI: 10.14744/tjtes.2024.64796

Medical management or surgery for acute cholecystitis: Enhancing treatment selection with decision trees

Ýsmail Sezikli¹, Mehmet Berksun Tutan¹, Veysel Barýþ Turhan¹, Murat Bulut Özkan², Ramazan Topcu^1
1Department of General Surgery, Hitit University Faculty of Medicine, Çorum-Türkiye
²Department of General Surgery, Güven Medicine, Ankara-Türkiye

BACKGROUND: This study aimed to create an algorithm using the decision tree method to classify patients with suspected acute cholecystitis into those who may improve with medical treatment, those who should undergo surgery for acute cholecystitis, and those with complicated cholecystitis, using laboratory parameters alone.
METHODS: A total of 1,352 patients treated for acute cholecystitis at our hospital over four years were retrospectively analyzed. Patients were divided into groups based on whether they received medical treatment or surgery. Various demographic and laboratory parameters were recorded. A decision tree algorithm was used to classify patients based on these parameters. Statistical analyses were performed using SPSS, and the decision tree's performance was evaluated with 10-fold cross-validation. An additional decision tree was created for gangrenous cholecystitis using the same methods.
RESULTS: The decision tree identified the platelet-to-lymphocyte ratio (PLR) as the most critical parameter for distinguishing between patients requiring surgery and those suitable for conservative treatment. The algorithm demonstrated an 82.17% diagnostic accuracy for predicting operative need and a 73.86% accuracy for identifying gangrenous cholecystitis. C-reactive protein (CRP) levels, platelet (PLT) values, white blood cell (WBC) counts, and patient age were also significant factors in the decision-making process. The neutrophil-to-lymphocyte ratio (NLR) was the most useful for diagnosing necrosis.
CONCLUSION: The decision tree algorithm effectively differentiates between uncomplicated and complicated cholecystitis using easily obtainable laboratory parameters. This method offers a cost-effective, rapid alternative to imaging studies, facilitating timely and appropriate treatment decisions, ultimately improving patient outcomes and reducing healthcare costs.

Keywords: Acute cholecystitis, conservative treatment, decision tree, diagnostic algorithm, gallstones, platelet-to-lymphocyte ratio

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Akut kolesistitte týbbi yönetim veya cerrahi: Karar aðaçlarý ile tedavi seçiminin güçlendirilmesi

Ýsmail Sezikli¹, Mehmet Berksun Tutan¹, Veysel Barýþ Turhan¹, Murat Bulut Özkan², Ramazan Topcu^1
1Hitit Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Çorum, Türkiye
²Güven Hastanesi, Genel Cerrahi Kliniði, Ankara, Türkiye

AMAÇ: Bu çalýþmada, akut kolesistit þüphesi olan hastalarý yalnýzca laboratuvar parametrelerini kullanarak medikal tedaviye uygun olanlar ve cerrahi müdahale gerektirenler olarak ayýrt etmeyi amaçlayan bir karar aðacý algoritmasý geliþtirilmiþtir.
GEREÇ VE YÖNTEM: Dört yýl içerisinde hastanemizde akut kolesistit nedeniyle tedavi edilen toplam 1352 hasta retrospektif olarak incelendi. Hastalar medikal tedavi görenler ve operasyon geçirenler olarak iki gruba ayrýldý. Çeþitli demografik ve laboratuvar parametreleri kaydedildi. Hastalarý bu parametrelere göre sýnýflandýrmak için bir karar aðacý algoritmasý kullanýldý. Algoritmanýn performansý 10 katlý çapraz doðrulama ile deðerlendirildi.
BULGULAR: Karar aðacý, cerrahi müdahale gereksinimini ayýrt etmede en kritik parametre olarak trombosit-lenfosit oranýný (PLR) belirledi. Algoritma, operatif ihtiyaç için %82.17 tanýsal doðruluk ve gangrenöz kolesistiti ayýrt etmede %73.86 doðruluk gösterdi. C-reaktif protein (CRP) seviyeleri, trombosit deðerleri, beyaz kan hücresi sayýmlarý ve hasta yaþý da karar verme sürecinde önemli faktörler olarak saptandý. Nekroz teþhisinde en yararlý parametre nötrofil-lenfosit oraný (NLR) oldu.
SONUÇ: Karar aðacý algoritmasý, komplike olmayan ve komplike kolesistiti, kolaylýkla elde edilebilir laboratuvar parametreleri kullanarak etkili bir þekilde ayýrt etmektedir. Bu yöntem, görüntüleme çalýþmalarýna hýzlý ve maliyet etkin bir alternatif sunmakta, zamanýnda ve uygun tedavi kararlarý alýnmasýna yardýmcý olarak hasta sonuçlarýný iyileþtirmekte ve saðlýk maliyetlerini azaltmaktadýr.

Anahtar Kelimeler: Akut kolesistit, karar aðacý, konservatif tedavi, safra kesesi taþlarý, taný algoritmasý, trombosit-lenfosit oraný

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