WTP3.2 Audit of percutaneous cholecystostomy practice against Tokyo Guidelines, 2012 – 2020

Abstract

Abstract Aims Percutaneous cholecystostomy (PC) is employed to improve prognosis when cholecystectomy is deemed inappropriate in high-surgical-risk patients with severe acute cholecystitis (AC). Tokyo guidelines (TG) 2013 and 2018 provide specific guidance on indications for PC. We aimed to audit the percutaneous cholecystostomy service at an adult tertiary centre to assess compliance with Tokyo Guidelines. Methods This was a single-centre, retrospective cohort audit. Patients with PC performed for AC during index admission between 2012 and 2020 constituted the study cohort, identified using the ICD-10 and OPCS-4 code the Trust business intelligence unit provided. Data was collected by inspection of electronic records. Patients were stratified into sub-groups by TG severity of AC, Charlson comorbidity index (CCI), ASA class, and NELA score. Management features of each subgroup were analysed to assess adherence to TG. Results Seventy-six patients (52.6% male) with a median age of 76 (IQR 67.5-83.3) were included. The median duration of acute biliary symptoms was 6.7 days (IQR 3.0-12.4). Seventy-three (96.1%) patients had at least one comorbidity. Fifty-three (69.7%) had a CCI of ≥4, and 56 (73.7%) had an ASA grade of ≥3. All 76 patients had appropriate pre-procedural imaging, and all had blood/bile cultures taken. Sixty-three (82.9%) patients received antibiotics immediately. When assessing for indications for PC, 29 patients (38.2%) met the severity grading (severe AC, grade 3). Twenty-eight patients (36.8%) met all Tokyo criteria for emergency PC. Conclusions PC is overperformed compared to the TG gold standard. Further evaluation of clinical outcomes in this cohort of patients is needed.