Percutaneous cholecystostomy is safe and effective option for acute calculous cholecystitis in select group of high-risk patients

• Published in: European journal of trauma and emergency surgery (Munich : 2007) Vol. 42; no. 6; pp. 761 - 766
• Main Authors: Bala, M., Mizrahi, I., Mazeh, H., Yuval, J., Eid, A., Almogy, G.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2016; Springer Nature B.V
• Subjects: Abdominal surgery; Aged; Cholecystectomy, Laparoscopic; Cholecystitis, Acute - mortality; Cholecystitis, Acute - surgery; Cholecystostomy - methods; Critical Care Medicine; Emergency Medicine; Female; Gallbladder diseases; Hospital Mortality; Humans; Inflammation; Intensive; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Postoperative Complications; Retrospective Studies; Risk Factors; Sports Medicine; Surgery; Surgical Orthopedics; Surgical outcomes; Traumatic Surgery; Treatment Outcome; Cholecystectomy; Surgical outcomes; Acute calculous cholecystitis; Percutaneous tube cholecystostomy
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-015-0601-1

Purpose In high-risk patients with acute calculous cholecystitis (ACC), percutaneous cholecystostomy (PC) can serve as a bridging option to cholecystectomy [laparoscopic cholecystectomy (LC)] or as definitive treatment. The purpose of this study was to identify predictors of the need for permanent PC. Methods Data from 257 PCs performed for ACC (mean age 67.3 ± 14) was collected for a 10-year period. Demographic and clinical characteristics at initial admission, co-morbidities were analyzed. Patients who underwent interval LC were defined as the surgery group (SG; n  = 163, 63.4 %) and the remaining patients as the non-SG (NSG; n  = 94, 36.6 %). Results Patients in the SG were significantly younger and had a shorter length of hospital stay ( p  < 0.01). The rate of coronary artery disease (CAD; 63.2 vs. 20.2 %), chronic renal failure (14.9 vs. 6.1 %), and the mean number of co-morbidities (2.2 vs. 1.4) were significantly higher in the NSG. Sepsis at admission was more common in the NSG (19.1 vs. 4.9 %, p  < 0.001). 56 patients (34.4 %) in the SG and 24 patients (25.5 %) in the NSG developed tube-related complications. In hospital mortality was similar between the groups. Multivariate analysis showed that age ≥75, increased alkaline phosphatase (ALK-P), history of CAD, were predictors of PC as a definite treatment in this high-risk group of patients with ACC. Conclusions High operative risk due to older age and CAD preclude LC in more than one-third of patients following PC especially presenting with sepsis and elevated ALK-P. This study suggests that PC could be a safe treatment option in this select group of high-risk patients.