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Cholecystostomy Treatment in an ICU Population: Complications and Risks
*Ann-Kristin U. Friedrich1, Kevin P. Baratta2, *Joanne Lewis2, *Adib R. Karam2, *Erica B. Sneider2, *Margaret Hudlin2, Demetrius E. M. Litwin2, Mitchell Cahan2
1St. Mary's Hospital, Waterbury, CT;2University of Massachusetts, Worcester, MA
Objective: Percutaneous cholecystostomy treatment has widely been used as alternative treatment to cholecystectomy, especially in advanced disease or critically ill patients. Reported post-procedural complication rates have varied significantly over the last decade. The goal of this study is to evaluate the safety of percutaneous cholecystostomy tube treatment in critically ill patients and the complications resulting from this intervention.
Design: Retrospective chart analysis and review of the literature.
Setting: Intensive care unit in a tertiary care center in central Massachusetts.
Patients: 96 critically ill patients who underwent cholecystostomy treatment during an ICU stay between 2005 and 2010.
Interventions: Percutaneous cholecystostomy treatment.
Main Outcome Measures: Complications within 72 hours of cholecystostomy tube placement and any morbitidy or mortality relating to presence of cholecystostomy tube.
Results: 65 male and 31 female patients with a mean age of 67.4 years underwent percutaneous cholecystostomy treatment during an ICU stay. 66 patients experienced a total of 121 complications, resulting in an overall complication rate of 69%. 61 of these complications resulted from the actual procedure or the presence of the cholecystostomy tube; the other 60 complications related to worsening clinical conditions with temporal relationship to the cholecystostomy procedure. 10 patients died with sequelae to cholecystostomy tube placement. Tube dislodgment was the most common complication with a total of 34 episodes.
Conclusions: Cholecystostomy tube placement is associated with severe complications and may contribute to serious morbidity and death in an ICU population. Complication rates may be underreported in medical literature. The potential impact of cholecystostomy treatment in critically ill patients should not be underestimated.
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