Does high surgical risk affect the management and outcomes of percutaneous cholecystostomy in acute cholecystitis? A single-center retrospective analysis

Abstract

We compared the management and results of percutaneous cholecystostomy (PC) in high surgical risk (HSR) and normal surgical risk (NSR) acute cholecystitis (AC) patients. The patients were divided into two groups: 60 patients with NSR and 30 patients with HSR. Pre-PC laboratory values, PC efficiency in terms of AC complications, catheter withdrawal method and duration, catheter-related complications, AC recurrence rate, mortality rate, presence of dyspeptic complaints in definitive PC, and cholecystectomy rate were compared. Technical and clinical success were achieved in 90 (100%) patients and, 85 (94.4%) patients with PC, respectively. The mortality developed in the HSR group; however, it was not seen in the NSR group (p=0.003). Five (83.3%) out of 6 (6.7%) patients with the American Society of Anesthesiology classification system (ASA) IV score developed mortality. With PC, clinical success was achieved in all 8 (100%) patients with suspected perforated cholecystitis and 6 (75%) of 8 patients with suspected emphysematous cholecystitis on abdominal CT in the non-acute abdomen. PC complications were seen in 8 (8.8%) and recurrent cholecystitis in 8 (12.5%) patients. The hospital stay was longer, and the rate of definitive treatment with PC was higher in the HSR group (p=0.019, p=0.008). C-reactive protein and procalcitonin levels were higher in the NSR group (p<0.001, p=0.001). Dyspeptic complaints did not observe in 28 (73.7%) of the 38 patients without operation during the 33.3-month follow-up. The rate was not different between the groups (p=0.713). PC provides high clinical success in AC-related major complications, severe infection, and the presence of serious comorbid diseases. Mortality was observed only in ASA IV patients. The definitive cure rate of PC was higher in patients with HSR.