Premium
Outcomes of percutaneous cholecystostomy and predictors of eventual cholecystectomy
Author(s) -
Yeo Charleen Shan Wen,
Tay Vivyan Wei Yen,
Low Jee Keem,
Woon Winston Wei Liang,
Punamiya Sundeep J,
Shelat Vishal G
Publication year - 2016
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.304
Subject(s) - medicine , cholecystectomy , cholecystostomy , comorbidity , perioperative , cholecystitis , charlson comorbidity index , surgery , retrospective cohort study , acute cholecystitis , mortality rate , percutaneous , apache ii , general surgery , gallbladder , intensive care unit
Background Percutaneous cholecystostomy (PC) is an established treatment for high surgical risk patients with acute cholecystitis. This paper studies factors predictive of mortality and eventual cholecystectomy. Methods A retrospective review of all patients who underwent PC from March 2005 to March 2015 was performed. Patient demographics, clinical features, comorbidity profile, grade of cholecystitis, interval between cholecystitis diagnosis and PC, and method of PC were studied. Length of stay, complications, readmission rate, mortality and eventual cholecystectomy were studied. For patients with eventual cholecystectomy, operative data and perioperative outcomes were studied. Results One hundred and three patients with median age of 80 years (range 43–105) underwent PC. Median interval to PC was 2 days (range 0–15). 9.7% of patients had complications. Median length of stay was 19 days (range 3–206). 41% underwent eventual cholecystectomy. 30‐day mortality rate was 10.7%. Higher APACHE II scores ( P = 0.004), higher Charlson comorbidity index (CCI) ( P = 0.009), and longer interval from diagnosis to PC ( P = 0.037) were associated with in‐hospital mortality. Younger age ( P = 0.015), lower APACHE II scores ( P = 0.043) and lower CCI ( P = 0.002) were associated with eventual cholecystectomy. Conclusion Percutaneous cholecystostomy is safe and effective in treatment of acute cholecystitis. Prompt PC improves survival in high risk surgical patients. Comorbidity severity is associated with mortality. Patients with lesser comorbidity are likely to receive eventual cholecystectomy.