Revisiting percutaneous cholecystostomy for acute cholecystitis based on a 10-year experience

To identify patient characteristics leading to percutaneous cholecystostomy (PC) and to compare outcomes between PC and cholecystectomy (CCY) in patients with acute cholecystitis (AC).

Retrospective cohort study. SETTING Veterans Affairs Boston Healthcare System.

All consecutive patients with AC per the Tokyo criteria who underwent PC or CCY from January 1, 2001, through December 31, 2010.

Differences in baseline characteristics and outcomes between PC and CCY patients, odds of PC vs CCY use, and odds of death after PC or CCY.

Of 480 CCY and 92 PC procedures, 150 CCY and 51 PC procedures were performed for AC. The PC patients were older (70.4 vs 65.0 years, P = .01) and had higher leukocyte counts (16 500 vs 14 700/μL [to convert to × 10⁹/L, multiply by 0.001], P = .046), alkaline phosphatase levels (198.2 vs 140.1 U/L [to convert to microkatals per liter, multiply by 0.0167], P = .02), Charlson comorbidity index scores (3.0 vs 1.0, P < .001), and American Society of Anesthesiologists class (P = .006) compared with CCY patients. The PC patients had longer intensive care unit stays (5.9 vs 2.3 days, P = .008), longer hospital stays (20.7 vs 12.1 days, P < .001), more complications per patient (2.9 vs 1.9, P = .01), and higher readmission rates (31.4% vs 13.3%, P = .006). On multivariate analysis, a Charlson comorbidity index score of 4 or higher was the only independent predictor of treatment with PC vs CCY (odds ratio, 1.226; 95% CI, 1.032-1.457) and was the only independent predictor of death after PC or CCY (odds ratio, 1.318; 95% CI, 1.143-1.521). No differences in survival were found between the PC and CCY groups (P = .14).

Compared with CCY, PC is associated with higher morbidity rates and should be reserved for patients with prohibitive risks for surgery.