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Objective: To compare patient characteristics and outcomes between percutaneous cholecystostomy (PC) and cholecystectomy (CCY) in patients with acute cholecystitis (AC).
Design: Retrospective cohort study. Setting: The VA-Boston Healthcare System.
Patients: All consecutive patients who underwent PC or CCY between 2001 and 2010; only those patients with AC as per the Tokyo Diagnostic Criteria were included.
Main Outcome Measures: Differences in baseline characteristics (demographics, clinical signs, laboratory/imaging data, ASA class, Charlson comorbidity index) and outcomes (length of hospitalization, complications) between PC and CCY patients.
Odds of PC insertion versus CCY per baseline characteristics.
Odds of death after PC or CCY per baseline characteristics.
Results: Out of 480 CCY and 92 PC procedures in total, 150 cholecystectomies and 51 cholecystostomies were performed for AC. PC patients were older (70.4 vs 65, p=0.0148), had higher leukocyte counts (16.5 vs 14.7 K/mm3, p=0.0465), Alkaline Phosphatase levels (198.2 vs 140.1 units/L, p=0.0194), Charlson comorbidity scores (3.6 vs 2.1, p<.0001), and ASA class (p=0.0061) compared to CCY patients. PC patients also had longer ICU stays (5.9 vs 2.3 days, p=0.0078), longer hospital stays (20.7 vs 12.1 days, p<.0001), a higher number of complications per patient (2.9 vs 1.9, p=0.0114), and longer readmissions (3.2 vs 1.2 days, p=0.0232). On multivariate analysis, a Charlson score of 4+ was the only independent predictor of treatment with PC versus CCY (OR=1.226; 95% CI=1.032-1.457), and was the only independent predictor of death after PC or CCY (OR=1.318; 95% CI=1.143-1.521). Differences in survival were non-significant between PC and CCY groups (p=0.1359).
Conclusions: PC is associated with significant morbidity and no survival advantage to CCY. The risks and benefits of PC compared to early CCY should be re-assessed.