192 Percutaneous cholecystostomy as a definitive treatment versus bridging treatment before cholecystectomy for acute cholecystitis: a retrospective observational study

Abstract

Abstract Aims In this study, we aimed to investigate the mortality and predictors of mortality of patients receiving percutaneous cholecystostomy (PC) as definitive treatment versus patients receiving PC followed by laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) Methods The study population consisted of 48 patients receiving PC for AC (mean age 76, 68.8% male), with a median follow-up period of 22 months. Data was collected on 1,3 and 12-month mortality, Charlson Comorbidity Index (CCI) and American Society of Anaesthesiology (ASA) score, admission bilirubin and respiratory function, and conversion to LC rates. Results 22 patients (46.8%) received LC following PC treatment, and 26 patients (54.2%) had PC as their definitive treatment. All 22 LC patients (100%) survived at 30 days, 3 months, and 12 months. Definitive PC patients had a 30-day mortality of 30.8% (8 patients), and a 3-month and 12-month mortality of 46.2% (12 patients). The alive cohort of patients had a lower CCI (4.66 vs 5.86, p<0.094), lower ASA (2.71 vs 3.25, p<0.05), and fewer patients with respiratory dysfunction or jaundice (27.8% vs 62%) than the 30-day and 3-month mortality cohort. The LC cohort had significantly lower CCI (4.39 vs 5.57, p<0.05), lower ASA (2.61 vs 3.04, p<0.05), but more jaundice/respiratory dysfunction (50% vs 38.4%) than the PC cohort. Conclusions Our results suggest that patient CCI score, ASA score, admission jaundice, and respiratory dysfunction can be used as effective predictors for 30-day and 3-month mortality for patients receiving PC for AC, as well as effective adjuncts in deciding which PC patients should be considered for surgery.