N Nowak, DO, Pk Bamberger. Reading Hospital
The first cholecystostomy was described in the late 1800s; however, since the resurgence of this procedure in the 1980s, countless studies have been published investigating its success and role in the treatment algorithm of acute cholecystitis. With emergency cholecystectomy mortality rates as high as 30% in critically ill elderly patients, the role of percutaneous cholecystotomy tube has been increasingly studied; however, little data exists to evaluate this patients as stratified by the latest NSQIP risk calculator.
The aim of this retrospective chart review was to investigate our single-center experience in management and long term follow up of patients with the diagnosis of acute cholecystitis (both calculus and acalculus) treated with percutaneous cholecystostomy between the years 2008-2013. In addition, we investigated which subset of patients eventually went on for interval cholecystectomy.
We performed a medical record search for CPT code 47490 “Percutaneous Cholecystotomy”. Pt demographics and comorbidities at initial presentation and at the time of interval operation were evaluated and analyzed. These data points were entered into NSQIP risk calculator. Primary outcomes considered were risk of “serious complication”, “any complication”, and “death”.
Forty-nine patients were found fitting our inclusion criteria. The median age was 78 (42 to 100 yrs). The mean BMI for these patients was 25.9. Four patients (8%) eventually had their cholecystotomy tube removed, sixteen (32.6%) patients died with their tube in place, twenty-five (51%) patients underwent interval cholecystectomy, one (2%) patient remains to date with tube in place, and three (6%) were lost to follow up. Using paired t-testing, we compared the NSQIP risk outcomes of the patient population at the time of their initial presentation to those that underwent interval cholecystectomy. Mean risk of serious complication, any complication, and death at time of initial presentation was 13.4%, 20.1%, and 5.86% respectively. At the time of interval cholecystectomy the same patients had statistically significant risk reductions in all three categories to 5.6%, 7.25%, and 2.19%.
Our data findings support percutaneous cholecystotomy with interval cholecystectomy in patients that are found to be high risk with appropriate time between procedures for acuity of other comorbid factors to resolve. Patients that underwent cholecystectomy had shorter length of stay than those that died with the drainage tube in place, suggesting that the operative group was overall healthier in general and able to tolerate the procedure and its post-operative course.