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Percutaneous cholecystostomy: prognostic factors and comparison to cholecystectomy
Tyler J Loftus1,2, Elisha M Collins1,2, Camille G Dessaigne1,2
1Department of Surgery, The University of Florida, Gainesville, FL, USA.
Insights
Percutaneous cholecystostomy (PC) outcomes show 30-day mortality linked to inflammation. Chronic diseases like cancer predict 1-year mortality, indicating higher long-term risks compared to cholecystectomy (CCY).
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Critical Care Medicine
Background:
- Limited data exists on long-term outcomes of percutaneous cholecystostomy (PC).
- Comparisons between PC and cholecystectomy (CCY) for acute cholecystitis are lacking.
- Chronic disease burden is hypothesized to predict mortality after PC.
Purpose of the Study:
- To evaluate predictors of 1-year mortality following PC.
- To compare long-term outcomes of PC versus CCY.
- To assess the impact of chronic disease burden on PC outcomes.
Main Methods:
- A 10-year retrospective cohort analysis of 114 PC patients and 234 CCY patients.
- Assessment of treatment response using Systemic Inflammatory Response Syndrome (SIRS) criteria.
- Logistic regression for mortality predictors and propensity-score matching for PC/CCY comparison.
Main Results:
- Persistent SIRS at 72 hours post-PC predicted 30-day mortality (OR 8.9).
- Independent predictors of 1-year mortality post-PC included DNR status, disseminated cancer, and congestive heart failure.
- Matched PC patients showed higher 180-day mortality (28.6%) compared to CCY (7.1%).
Conclusions:
- Treatment response to PC predicts 30-day mortality.
- DNR status and chronic diseases are significant predictors of 1-year mortality after PC.
- PC is associated with higher long-term mortality than CCY, even after controlling for risk factors.
Background:
Data regarding long-term outcomes following percutaneous cholecystostomy (PC) are limited, and comparisons to cholecystectomy (CCY) are lacking. We hypothesized that chronic disease burden would predict 1-year mortality following PC, and that outcomes following PC and CCY would be similar when controlling for preprocedural risk factors.
Methods:
We performed a 10-year retrospective cohort analysis of patients with acute cholecystitis managed by PC (n = 114) or CCY (n = 234). Treatment response was assessed by systemic inflammatory response syndrome (SIRS) criteria at PC/CCY and 72 h later. Logistic regression identified predictors of 30-day and 1-year mortality following PC. PC and CCY patients were matched by age, Tokyo Guidelines (TG13) cholecystitis severity grade, and VASQIP calculator predicted mortality (n = 42/group).
Results:
The presence of SIRS at 72 h following PC was associated with 30-day mortality [OR 8.9 (95% CI 2.6-30)]. SIRS at 72 h was present in and 21.4% of all PC patients, significantly higher than unmatched CCY patients (4.7%, p = 0.048). Independent predictors of 1-year mortality following PC were DNR status [19.7 (2.1-186)], disseminated cancer [7.5 (2.1-26)], and congestive heart failure [3.9 (1.4-11)]. PC patients with none of these risk factors had 17.9% 90-day mortality and no deaths after 90 days; late deaths continued to occur among patients with DNR, CHF, or disseminated cancer. At baseline, PC patients had greater acute and chronic disease burden than CCY patients. After matching, PC and CCY patients had similar age (69 vs. 70 years), TG13 grade (2.4 vs. 2.4), and predicted 30-day mortality (5.5 vs. 6.8%). Matched PC patients had higher 30-day mortality (14.3 vs. 2.4%, p = 0.109) and 180-day mortality (28.6 vs. 7.1%, p = 0.048).
Conclusions:
Treatment response to PC predicted 30-day mortality; DNR status, and chronic diseases predicted 1-year mortality. Although the matching procedure did not eliminate selection bias, PC was associated with persistent systemic inflammation and higher long-term mortality than CCY.