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A Single Institution Experience with Percuateneous Cholecystostomy
*Gabriella Grisotti, *Bishwajit Bhattacharya, *Robert Schlessel, *Joseph T King, Jr, *Gowthaman Gunabushanam, Melissa F Perkal
Yale University School of Medicine, New Haven, CT
Objective: Percutaneous cholecystostomy (PC) has emerged as a safe interval technique to decompress the gallbladder in patients diagnosed with acute cholecystitis but who are too ill for a surgical cholecystectomy. We analyzed shortand long term outcomes of patients undergoing this ‘temporary’ procedure.
Design: A single institution retrospective analysis of 124 patients.
Setting: West Haven Veterans Affairs Hospital from November 2003 to June 2013.
Patients: Patient population consisted of all men, with a mean age of 70.2 years + 11.1 (SD) years. Seventy-three patients (59%) were admitted with a primary diagnosis of biliary disease, while fifty-one patients (41%) were diagnosed with biliary disease during their hospitalization for another disease. Thirty three patients (27%) were located in an intensive care unit at the time of diagnosis.
Main Outcome Measures: 30 day and 6 month survival, drain outcomes, and definitive treatment with surgical cholecystectomy.
Results: Sixteen patients (13%) died within 30 days of PC, an additional 13 (10%) died within 6 months of PC, and the median survival was 4.8 years. Twenty eight patients had tube related complications (23%), for which fifteen patients (12%) required hospitalization. Only 53 patients (43%) proceeded to surgical cholecystectomy. Multivariate analysis demonstrated a significant positive association between increased mortality and respiratory failure (HR 2.23, 95% CI: 1.25, 4.95; P=0.007), age (HR 1.03, 95% CI: 1.01, 1.06; P=0.037), alkaline phosphatase (HR 1.002, 95% CI: 1.001, 1.003; P=0.001), and a negative association with surgical cholecystectomy (HR 0.37, 95% CI: 0.19, 0.72; P=0.003).
Conclusions: Only 43% of patients eventually underwent surgical cholecystectomy. Outcomes and quality of life should impact discussions with patients and their decision-makers when opting for
PC in critically ill patients with respiratory failure.
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