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Percutaneous Cholecystostomy for Acute Cholecystitis: Patient Characteristics and Clinical Outcomes
*Betty Yang, *Robert R. Miller, *Ranjendran Vilvendhan, Peter A. Burker, *George Kasotakis, *Bedabrata Sarkar
Boston University Medical Center, Boston, MA
Objective: The objective of this study was to define the role of percutaneous cholecystostomy as definitive treatment for acute cholecystitis in high risk patients. We hypothesized that considering patient acute physiology and comorbidities would predict who would benefit from delayed or non-operative management.
Design: Retrospective chart review.
Setting: Urban, tertiary care, safety-net hospital.
Patients: Patients diagnosed with cholecystitis who underwent percutaneous cholecystostomy at this single tertiary care center between January 2008 and December 2013.
Intervention: Percutaneous cholecystostomy.
Main Outcome Measures: Hospital stay, readmission rates, reintervention with percutaneous cholecystostomy, subsequent cholecystectomy, and mortality rates.
Results: Mean patient age was 67.7 years (range 22-97). Male patients represented 61.6% of our cohort. Over 89% of patients had multiple comorbidities. After initial percutaneous cholecystostomy, 33% of patients were readmitted to the hospital for gallbladder-related issues. Ultimately 30.4% of patients underwent cholecystectomy: of these operations, 64.7% were laparoscopic, 20.6% were open, and 14.7% began laparoscopic and converted to open. Eight percent of patients required repeat percutaneous cholecystostomy. Overall mortality was 24.1%, with in-house mortality 10.7%. Among those who underwent surgery, 3 of 34 (8%) patients died outside of the hospital. Among those who did not undergo surgery, the mortality was 32%.
Conclusions: Percutaneous cholecystostomy is a low-risk, effective treatment in the short-term, however there is a significant rate of recurrent cholecystitis and need for reintervention. Of the patients who undergo surgery, the majority were able to be performed laparoscopically. We conclude that percutaneous cholecystostomy plays a useful role for interval cholecystectomy in patients with acute medical issues, although its contribution as definitive treatment for patients with prohibitive risk remains undefined.
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