Abstract
BackgroundControversy surrounding the role of percutaneous cholecystostomy (PC) is fed by the absence of large amounts of data concerning its outcomes, and many authors have maintained that there is no evidence to support a recommendation for PC rather than cholecystectomy (CCS) in elderly or critically ill patients with acute cholecystitis (AC).MethodsWe conducted this study by tracking trends in the utilization and outcomes of PC and CCS using longitudinal health research data in Taiwan.ResultsAnalyses were conducted on 236,742 patients, 11,184 of whom had undergone PC and 225,558 of whom had undergone CCS. Average annual percentage changes (AAPCs) from 2003 to 2012 increased significantly by 18.34% each year for PC and by 2.82% each year for CCS. The subset analyzes showed that the mortality rates were far higher in patients underwent PC than in patients underwent CCS in all subgroups, which increased from a minimum of 1.45-fold to a maximum of 34.22-fold. The gap of the mortality rates between PC group and CCS group narrowed as the patients aged and with the seriousness of the diseases increased. Most patients with PC or CCS who died in-hospital or within 30 days after discharge were 70 years of age or older, and a large number of them received a CCI score of at least 1. The AAPCs of the overall mortality rates from 2003 to 2012 decreased by 6.78% each year for PC and by 7.33% each year for CCS. PC was related to a higher rate of cholecystitis recurrence and readmission for complications, but a lower rate of in-hospital complications and routine discharge than CCS, and 36.41% of all patients treated with PC underwent subsequent CCS. Additionally, the patients with PC experienced longer hospital stays and generated higher costs than the patients with CCS.ConclusionPatients who underwent PC demonstrated poorer prognoses than did patients who underwent CCS. The role of PC in the Tokyo guidelines may be overstated; it is not as safe as the Tokyo guidelines have suggested in moderate-grade cholecystitis cases, and it should be limited to only the elderly and sicker patients.
Highlights
Controversy surrounding the role of percutaneous cholecystostomy (PC) is fed by the absence of large amounts of data concerning its outcomes, and many authors have maintained that there is no evidence to support a recommendation for Percutaneous cholecystostomies (PCs) rather than cholecystectomy (CCS) in elderly or critically ill patients with acute cholecystitis (AC)
We found that the proportion of males was significantly higher than that of females among patients who died during hospitalization for both operation types (60.32% were male for PC, 62.22% were male for CCS, respectively), the total number of patients was closely balanced between males and females (50.31% for females vs. 49.69% for males, p < 0.001), indicating that males may be more vulnerable than females
In conclusion, the present study found that patients after PC had some poor prognoses compared with patients after CCS, such as a higher rate of mortality and cholecystitis recurrence, but a lower rate of routine discharge
Summary
Controversy surrounding the role of percutaneous cholecystostomy (PC) is fed by the absence of large amounts of data concerning its outcomes, and many authors have maintained that there is no evidence to support a recommendation for PC rather than cholecystectomy (CCS) in elderly or critically ill patients with acute cholecystitis (AC). Percutaneous cholecystostomies (PCs), which involve percutaneous, imagingguided catheter placement in the gallbladder lumen, were first described by Radder in 1980 [4] This procedure allows for the immediate decompression of an acutely inflamed gallbladder, requires the use of only local anesthesia, eliminating the need for surgery, and can serve as either a bridge to surgery or as a definitive treatment designed for unfit patients and for those who refuse to undergo CCS [5,6,7,8]. We could not determine whether the Tokyo guideline recommendations were adequate and current or whether they should be revised due to the lack of large amounts of data
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