Timing of cholecystectomy following cholecystostomy tube placement for acute cholecystitis: a retrospective study aiming to identify the optimal timing between a percutaneous cholecystostomy and cholecystectomy to reduce the number of poor surgical outcomes.

Abstract

Our study aims to identify the optimal timing between a percutaneous cholecystostomy (PC) and cholecystectomy to reduce the number of poor surgical outcomes. Biliary disease is a common surgical disease and laparoscopic cholecystectomy is the preferred strategy for the management of acute cholecystitis. However, in high-risk surgical patients, a PC tube may be placed instead. In the 2018 Tokyo Guidelines, the optimal timing of cholecystectomy following a PC has been identified as an important future research question. This is a retrospective study that focuses on identifying the ideal timing of cholecystectomy after PC tube placement to minimize complications. Poor surgical outcomes were measured as 90-day reoperations, 30-day readmissions, 30-day emergency department (ED) visits, length of stay (LOS), and discharge destination. Patients were selected from the New York SPARCS database from 2005 to September 30, 2015. 1213 records that consisted of both PC and cholecystectomy were collected. No significant differences in 30-day readmissions, 90-day reoperations, and 30-day ED visits in relation to timing between PC and cholecystectomy were found. Additionally, the decision to replace or not replace dislodged PC tubes was not associated with 90-day reoperation, 30-day readmission, 30-day ED visit, LOS, or discharge destination. However, discharge destination and LOS were significantly different between early intervention of 3days or less between PC and cholecystectomy and late intervention of more than 14days with late intervention being associated with shorter LOS and more home discharges. Performing a cholecystectomy more than 14days after a PC is associated with better surgical outcomes.