Maria S Altieri, MD, MS1, Jie Yang, PhD2, Donglei Yin, MS2, Konstantinos Spaniolas, MD2, Michael Brunt, MD1, Mark Talamini, MD, MBA2, Aurora Pryor, MD2. 1Washington University School of Medicine, 2Stony Brook University Hospital
Introduction: Percutaneous cholecystostomy tube (PCT) placement is often the initial management approach to severe acute cholecystitis in the unstable patient. However, the timing of cholecystectomy after PCT has not been carefully examined. The purpose of this study was to compare outcomes of early vs. late cholecystectomy following PCT placement.
Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) administrative longitudinal database was searched for all patients undergoing PCT placement between 2000-2012. Patients with missing information, 8 weeks) groups. Outcomes included overall complications, common bile duct injury (CBD injury), 30-day readmissions, 30-day Emergency Department (ED) visits, and length of stay (LOS). Chi-square tests with exact P-values based on Monte Carlo simulation were utilized to examine the difference in patients’ characteristics, comorbidities and complications. Multivariable logistic regression models (GLM) were further used to examine the differences in clinical outcomes between these two groups, after adjusting for variables which were significant in the univariate analysis at a significance level of 0.05.
Results: There were 9,728 patients who underwent PCT placement identified during the time period. as early subsequent cholecystectomy was performed in 1,211 patients (40.4%) , while 1,787 (59.6%) patients had a late cholecystectomy. Average time to cholecystectomy was 38 days +/- 12.7 days in the early group, vs 203 +/- 350 days in the late group. After adjusting for other confounding factors, patients with early cholecystectomy had a significantly higher rate of overall complications and longer LOS compared to the late cholecystectomy group (p=0.01 and p=0.0004, respectively). There were no significant differences in 30-day readmissions and 30-day ED visits. Furthermore, there was no significant difference between rates of CBD injury between the two groups (n=21 (1.7%) in the early cholecystectomy group and n=26 (1.5%) in the late cholecystectomy group).
Conclusion: Early cholecystectomy (≤8 weeks) is associated with a higher rate of complications and longer hospital LOS compared to cholecystectomy performed at >8 weeks. Surgeons should be aware and should delay cholecystectomy beyond 8 weeks to improve outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94011
Program Number: S003
Presentation Session: Biliary
Presentation Type: Podium