Steven Schulberg, DO, Jonathan Gumer, DO, Matt Goldstein, Vadim Meytes, DO, George Ferzli, MD. NYU Langone Hospital – Brooklyn
Introduction: Acute cholecystitis is a common surgical disease with roughly 500,000 cholecystectomies performed in the US annually. The current dogma revolves around the “72 hour rule” advocating early cholecystectomy if within the window, and if beyond 72 hours, conservative treatment and interval operation. In patients beyond the 72 hour window, as well as with multiple comorbidities, advanced age, and other complicating factors, cholecystostomy has become an acceptable treatment as a bridge to interval cholecystectomy. While this has become an appropriate treatment modality, it does not come without its own set of complications. We aim to evaluate the rate of complications in our institution.
Methods: This is a retrospective review of all patients at our institution who underwent cholecystostomy placement between 2013 and 2016. We evaluate the comorbidities, readmission rate, overall rate of complication associated with cholecystostomy tubes, and eventual definitive cholecystectomy.
Results: Our cohort includes 100 patients, 52% of whom were male, with a mean age of 71. We had an overall complication rate of 49.5%, including tube dislodgements, leaking tubes, and misplaced tubes. All cause readmission rate was 56% and only 32% of patients who had cholecystostomy drains underwent interval cholecystectomy.
Conclusion: There has been much interest in treatment of acute cholecystitis in patients with multiple comorbidities. In review of our data, a surprisingly large number of patients had mechanical complications involving the cholecystostomy drain. In an era focused on decreasing readmission rates and their associated costs, drains carry a high risk of malfunction which will in turn, lead to increases in these two metrics. While there is more work to be done in the evaluation of early cholecystectomy versus cholecystostomy in this subgroup of patients, we suspect that early cholecystectomy in the medically optimized patient will lead to reduced length of stay and hospital costs as well as increased patient satisfaction.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85017
Program Number: P092
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster