Outcome of conservative percutaneous cholecystostomy in high-risk patients with acute cholecystitis and risk factors leading to surgery.

Abstract

Laparoscopic cholecystectomy (LC) is the treatment of choice for acute cholecystitis. However, the morbidity and mortality rates are high in elderly patients or in those with co-morbidities at the time of surgery. Percutaneous cholecystostomy (PC) is a safe treatment for acute inflammation of the gall bladder. This study aimed to evaluate the safety and efficacy of PC for acute cholecystitis and investigate the post-PC factors leading to subsequent LC. Ninety-three patients with acute cholecystitis who underwent PC between August 2006 and December 2012 were retrospectively reviewed for clinical course, outcomes, and prognosis. We evaluated patient age, the presence of co-morbidities, American Society of Anesthesiologists (ASA) score, duration of drainage of the PC tube, performance of LC, conversion rate, hospital stay, recurrence, and 30-day mortality. We compared these characteristics in two study groups: 31 were treated with only conservative PC (group I) and 62 with PC followed by elective LC (group II). Patients in group I were older than those in group II (80.38 ± 10.05 vs. 70.50 ± 11.81 years, p < 0.001). More group I patients had an ASA score of III or IV (deemed high risk for surgery) compared to group II patients (80.6 %, n = 25 vs. 37.0 %, n = 23, p = 0.0012). Age, ASA score, and cerebrovascular accident (CVA) were significantly correlated when analyzing factors used to decide surgery (R (2) = 0.15, p < 0.001; R (2) = 0.21, p < 0.001; R (2) = 0.05, p = 0.05, respectively). Two patients in group I died within 30 days. Six patients (19.3 %) in group I experienced recurrent cholecystitis after PC tube removal. PC is a safe and effective therapeutic option in high-risk patients with acute cholecystitis, or for preoperative management. The decisive risk factors for surgery after PC were age, ASA score, and CVA.