Publication:

Short-term outcomes in percutaneous cholecystostomies: a retrospective cohort study

Background Elderly patients account for over 50% of patients presenting with acute cholecystitis. High risk surgical candidates are often treated with a percutaneous cholecystostomy (PC) as an alternative to acute surgery. This study aims to determine whether any factor during the index admission with acute calculus cholecystitis treated with PC determines whether a delayed cholecystectomy is performed, in addition to whether there are any predictive factors for the presence of ductal stones or recurrent biliary morbidity.

Methods A single-centred retrospective cohort study on radiologically inserted PCs for calculous cholecystitis between 2011-2017. Patient, radiological, biochemical and microbiological data were collected during the index admission. Primary outcome was whether the patient underwent a cholecystectomy and secondary outcomes included readmission with a further biliary morbidity or ductal stones necessitating an ERCP within 120days of the index cholecystostomy.

Results 32 patients (median age 77years, median Charlson Index 5) underwent PC with a median follow up of 151 days (range 27-1113). PC drain-related morbidity was 58% with no 30-days or in-hospital mortality. Patient age (p=0.007), Charlson Index (p=0.015) and a positive bile culture (p=0.032) were associated with a delayed cholecystectomy (38.7% of patients). There were no predictive variables for recurrent biliary morbidity within 90days (38.7%). CRP (p=0.045), ALP (p=0.035) and ALT (p=0.047) were predictive of the need for an ERCP for CBD stones (32.3%).

Conclusions PC is a safe procedure and is effective in overcoming the acute pathology in this comorbid population. However, the near-term prevalence of CBD stones and risk of further biliary morbidity remains significant suggesting that definitive surgery should be considered in suitable cases.