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Timing of cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis: a nationwide
Takashi Sakamoto1, Michimasa Fujiogi2, Hiroki Matsui2
1Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
Insights
The optimal time for cholecystectomy after percutaneous transhepatic gallbladder drainage (PTGBD) for acute cholecystitis is between 7 and 26 days. Intervals outside this range are associated with increased mortality and morbidity.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Medical Informatics
Background:
- The ideal timing for cholecystectomy after percutaneous transhepatic gallbladder drainage (PTGBD) in acute cholecystitis is not well-defined.
- PTGBD is a common temporizing measure for acute cholecystitis, but its optimal integration with definitive surgical management requires further investigation.
Purpose of the Study:
- To determine the optimal interval between PTGBD and cholecystectomy for acute cholecystitis.
- To analyze the association between the PTGBD-to-cholecystectomy interval and key patient outcomes.
Main Methods:
- Analysis of a national database including 9,256 patients who underwent cholecystectomy after PTGBD for acute cholecystitis.
- Restricted cubic spline (RCS) analyses were employed to model the relationship between the interval and outcomes.
Main Results:
- Reverse J-shaped associations were observed between the interval and mortality/morbidity, as well as blood transfusion rates.
- J-shaped associations were found for duration of anesthesia and postoperative hospital stay.
- Suboptimal intervals (e.g., ≤6 or ≥27 days for mortality/morbidity) were linked to poorer outcomes compared to optimal intervals.
Conclusions:
- The optimal window for performing cholecystectomy after PTGBD in acute cholecystitis appears to be between 7 and 26 days.
- Adhering to this interval may help minimize mortality, morbidity, and other adverse surgical outcomes.
Background:
Optimal interval from percutaneous transhepatic gallbladder drainage (PTGBD) to cholecystectomy for acute cholecystitis remains unclear.
Methods:
We analyzed patients undergoing cholecystectomy following PTGBD for acute cholecystitis, using a national database. We performed restricted cubic spline (RCS) analyses to investigate the association of interval from PTGBD to cholecystectomy with outcomes (mortality/morbidity, blood transfusion, duration of anesthesia, and postoperative hospital stay).
Results:
Among 9,256 patients, RCS analyses showed reverse J-shaped associations of the interval with mortality/morbidity and blood transfusion, and J-shaped associations of the interval with both duration of anesthesia and postoperative hospital stay. Each interval was compared with the bottom of the spline curve. Patients with intervals ≤6 days or ≥27 days had higher mortality/morbidity than those with a 10-day interval. Patients with intervals ≤8 days had higher proportions of blood transfusion than those with a 10-day interval. Patients with intervals ≥17 days had longer duration of anesthesia than those with a 5-day interval. Postoperative hospital stay was longer among those with intervals ≤10 days or ≥19 days than those with a 15-day interval.
Conclusions:
Based on the mortality/morbidity data, the optimum time to perform cholecystectomy is between 7 and 26 days after PTGBD.
