Maria S Altieri, MD, MS, Jie Yang, PhD, Donglei Yin, MS, Salvatore Docimo, MD, Konstantinos Spaniolas, MD, Mark Talamini, MD, MBA, Aurora Pryor, MD. Stony Brook University Hospital
Introduction: Percutaneous cholecystostomy tube (PCT) placement is often the initial management of severe acute cholecystitis in the unstable patient. PCT can be later reversed and cholecystectomy performed. The rate of cholecystectomy following PCT is not well characterized. The purpose of this study is to investigate the rate of subsequent cholecystectomy and clinical factors associated with subsequent procedure.
Methods: The SPARCS, an administrative database, which captures all inpatient and outpatient procedures in the state of New York, was used to search all patients undergoing PCT placement between 2000-2012. Patients age <18 years, missing information, lost-to-follow up, and with in-hospital deaths were excluded from the analysis. Using a unique identifier all patients were followed for subsequent cholecystectomy procedures for at least two years. Patients were also followed up for potential CBD injury during subsequent laparoscopic (LC) or open cholecystectomy (OC). Chi-square tests with exact P-values based on Monte Carlo simulation, and multivariable logistic regression model were used to in the univariate and multivariable analysis, respectively.
Results: Using ICD-9 and CPT codes, 9,738 patients were identified who underwent PTC placement in the time period. The top five most common causes of PTC placement were coded as biliary tract disease (57.74%), followed by septicemia (14.9%), pancreatic disorders (2.68%), complications of surgical procedures and medical care (2.1%), and acute myocardial infarction (1.7%). The rate of patients who had a PTC in 2000 to 2012, which subsequently underwent cholecystectomy increased from 25% in 2000 to 31.7% in 2012. In addition, patients undergoing subsequent LC increased from 11.8% in 2000 to 22.2% in 2012, while rate of OC decreased from 13.2% in 2000 to 9.5% in 2012. After accounting for other possible confounding variables, younger male patients, who didn’t have any complications during PTC placement were more likely to undergo subsequent cholecystectomy (p<0.05). Average time to LC was 122.02 days vs 159.64 days for OC (p-value <0.0001). From the patients who underwent cholecystectomy following PTC, 47 patients experienced CBD injury (1.57%).
Conclusion: Rate of cholecystectomy following PTC increased during the study period. Surgeons seem to be increasingly comfortable performing LC as rate of LC increased from 11.8% to 22.2%. However, rate of CBD injury is higher during subsequent cholecystectomy compared to that of the general population. Caution should be used when performing subsequent cholecystectomy following PTC, as these procedures may be more technically challenging.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88259
Program Number: S018
Presentation Session: Biliary Session
Presentation Type: Podium
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