HPB P58 Does percutaneous cholecystostomy timing in high anaesthetic risk patients impact on outcome?

Abstract

Abstract Background Little is known as to whether early percutaneous cholecystostomy (PCT) is favourable to patient outcome in the acute setting compared to delayed PCT placement. We aimed to study local factors influencing the timing to PCT placement, and investigate patient outcomes in early (≤ 48 hours) vs. delayed PCT over a six year period. Methods A retrospective observational study investigating patients who required a PCT at a single Trust in the UK between January 2014 and December 2019. Placement of a PCT was at the discretion of the on-call surgical consultant according to their own personal experience. Clinical outcomes, hospital statistics and details of any subsequent surgery were analysed using multivariate logistic regression models adjusting for age, sex, Charlson Comorbidity Index (CCI) and American Society of Anaesthesiologists (ASA) grade. Results There were 72 patients; 26/72 (36.1%) had an early PCT placed and 46/72 (63.9%) delayed. Median age was 76 (65–83) years, 52.8% were female, and 51.4% were classed ASA ≥3 with 94% scoring CCI >2. In adjusted models, early PCT was associated with a shorter length in hospital stay (OR 3.02, p =0.044), improved definitive treatment (OR 6.26, p =0.009); and reduced likelihood for catheter dislodgment (OR 0.12, p =0.004) with fewer patients bridging to emergency open surgery (OR 0.19, p =0.024). Conclusions Clinical outcomes may be superior in early PCT for high anaesthetic-risk patients following acute biliary sepsis but uncertainty remains. High quality prospective data are required to determine the effects of PCT timing on clinical outcomes and hospital statistics.