Early percutaneous cholecystostomy in severe acute cholecystitis reduced patients’ in-hospital days

Abstract

Background: Percutaneous cholecystostomy is an alternative treatment for emergent cholecystectomy in severe acute cholecystitis patients. The adequate timing to perform percutaneous cholecystostomy is still unclear. Aims: The aim of this study was to determine the adequate timing for percutaneous cholecystostomy in patients of severe acute cholecystitis. Methods: From 2008 to 2010, patients treated by percutaneous cholecystostomy for acute cholecystitis in a single medical center were retrospectively reviewed. Results: A total of 218 patients were reviewed including 156 male and 62 female. The mean age was 74.3 years old. We divided the patients in three groups according to the time period between percutaneous cholecystostomy and the time when the procedure was indicated. The numbers of patients are group A, <12 hours, n=75; group B, 12-48 hours, n=70, and group C, >48 hours, n=73. The baseline characteristics analysis showed significant older age in group A (A, 7.2; B, 74.6; C, 71.0 year-old, P=0.043). The indications of percutaneous cholecystostomy showed there was a higher percentage of sepsis in group A than in the other two groups (A, 33.3%; B, 31.43%; C, 16.4%, P=0.042). The lab data before percutaneous cholecystostomy demonstrated that there were higher total bilirubin level (A, 2.97; B, 1.80; C, 2.00 mg/dl, P=0.019) and AST (A, 129.7; B, 70.3; C, 59.1 U/L, P=0.004) in group A. Although worst in lab data, the group received percutaneous cholecystostomy early within 12 hours (group A) had significantly less in-hospital days (A, 15.95; B, 18.49; C, 22.19 day, P=0.039). Notably, no significant higher incidence of the procedure-related complications including dislodgement, bleeding, malposition, bile leakage, and infection was found in group A. In addition, no significant difference of in-hospital mortality was found among three groups. Conclusions: Early percutaneous cholecystostomy within 12 hours from the indicated time can reduce in-hospital days without increasing the procedure related complications and in-hospital mortality. Further prospective study is deserved to prove this concept and improve patient care.