Abstract
Background: Cholecystectomy (CCY) is the only definitive therapy for acute cholecystitis. We conducted this study to evaluate which patients may not benefit from further CCY after percutaneous transhepatic gallbladder drainage (PTGBD) has been performed in acute cholecystitis patients.Methods: Acute cholecystitis patients with PTGBD treatment were selected from one million random samples from the National Health Insurance Research Database obtained between January 2004 and December 2010. Recurrent biliary events (RBEs), RBE-related medical costs, RBE-related mortality rate and an RBE-free survival curve were compared in patients who accepted CCY within 2 months and patients without CCY within 2 months after the index admission.Results: Three hundred and sixty-five acute cholecystitis patients underwent PTGBD at the index admission. A total of 190 patients underwent further CCY within 2 months after the index admission. The other 175 patients did not accept further CCY within 2 months after the index admission. RBE-free survival was significantly better in the CCY within 2 months group (60 vs. 42%, p < 0.001). The RBE-free survival of the CCY within 2 months group was similar to that of the no CCY within 2 months group in patients ≥ 80 years old and patients with a Charlson Comorbidity Index (CCI) score ≥ 9.Conclusions: We confirmed CCY after PTGBD reduced RBEs, RBE-related medical expenses, and the RBE-related mortality rate in patients with acute cholecystitis. In patients who accepted PTGBD, the RBE and survival benefits of subsequent CCY within 2 months became insignificant in patients ≥ 80 years old or with a CCI score ≥ 9.
Highlights
Cholelithiasis is one of the most popular diseases with increasing prevalence and substantial burden on healthcare resources [1, 2]
Patients with acute cholecystitis were selected using ICD-9 codes documented in 2004–2010 to ensure the follow-up period is more than 1 year, and we identified patients who underwent percutaneous transhepatic gallbladder drainage (PTGBD) during an index admission or during an emergency room (ER) course 3 days before admission
Because the follow-up period should be at least 1 year, we included 377 acute cholecystitis patients who underwent PTGBD between January 2004 and December 2010
Summary
Cholelithiasis is one of the most popular diseases with increasing prevalence and substantial burden on healthcare resources [1, 2]. After the diagnosis of acute cholecystitis, evaluations of the disease severity are necessary [9] to guide clinical management, such as early cholecystectomy (CCY) or percutaneous transhepatic gallbladder drainage (PTGBD), especially in critically ill patients [10, 11]. CCY is the only definitive therapy for acute cholecystitis [9, 17, 18], there are patients who cannot tolerate or do not want surgical intervention despite the benefits of early or delayed CCY. Patients with acute cholecystitis, who were successfully treated by PTGBD, should accept further early, interval, or delayed CCY to prevent future RBEs. Cholecystectomy (CCY) is the only definitive therapy for acute cholecystitis. We conducted this study to evaluate which patients may not benefit from further CCY after percutaneous transhepatic gallbladder drainage (PTGBD) has been performed in acute cholecystitis patients
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