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Safety of Percutaneous Cholecystostomy Early Removal: A Retrospective Cohort Study
Marcello Di Martino1, Diana Miguel Mesa2, José María Lopesino González2
1Department of Surgery, HPB Unit.
Insights
Early removal of percutaneous cholecystostomy (PC) drainage during hospitalization did not increase complications. However, removing the PC catheter before seven days was linked to higher rates of recurrent gallstone disease and readmissions.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Patient Safety
Background:
- Management guidelines for percutaneous cholecystostomy (PC) are not well-established.
- This study aimed to evaluate the safety of early PC removal concerning complications and disease recurrence.
Purpose of the Study:
- To assess the safety and outcomes of early versus delayed percutaneous cholecystostomy removal.
- To compare complication rates, recurrent disease, and readmissions based on PC removal timing.
Main Methods:
- Retrospective observational study of 151 patients undergoing PC for acute cholecystitis (2012-2017).
- Patients were grouped by inpatient (IPR) versus outpatient (OPR) removal, and by removal within 7 days (G1) versus after 7 days (G2).
- Evaluated PC-related complications, recurrent disease, and readmissions.
Main Results:
- No significant difference in complications between IPR and OPR groups.
- Group 1 (PC removed ≤7 days) showed a higher rate of recurrent disease (32.1% vs. 14.7%) and readmissions (30.3% vs. 13.6%) compared to Group 2 (PC removed >7 days).
- Group 1 also had a shorter antibiotic duration (11 days vs. 15 days).
Conclusions:
- Percutaneous cholecystostomy removal during the initial hospital stay is safe regarding complications.
- Removing the PC catheter before seven days may increase the risk of recurrent gallstone disease and hospital readmissions.
Introduction:
There are no strong recommendations regarding the management of percutaneous cholecystostomy (PC). The aim of this study was to assess the safety of early PC removal in terms of complications and recurrent disease.
Materials And Methods:
Retrospective observational study of consecutive patients who underwent PC for acute cholecystitis from January 2012 to December 2017. We first evaluated PC-related complications and recurrent disease in patients whose drainage was removed as inpatients (IPR) or as outpatients (OPR). Patients were then divided into 2 groups according to the timing of PC removal: G1 with the PC removed within the first 7 days after its collocation and G2 with the PC removed after 7 days.
Results:
We included 151 patients. Patients in the OPR group had their catheters removed after 52 days (26 to 67 d) while the IPR group after 8 days (6 to 11 d); P<0.001. No difference was seen regarding complications, recurrent disease rate, or readmissions.G1 was comprised of 56 patients (37.1%), whereas G2 had 95 (62.9%). When G1 was compared with G2, no differences were seen in terms of complications. However, G1 presented a shorter duration of antibiotic treatment with 11 days (8 to 14 d) versus 15 days (12 to 23 d) in G2; P<0.001, but had a higher rate of recurrent disease 32.1% versus 14.7% in G2; P=0.014 and a higher rate of readmission 30.3% versus 13.6% in G2; P=0.019.
Conclusions:
Removal of the PC during the index admission was not associated with a higher risk of complications. However, the PC removal before 7 days could be related to an increase in recurrent disease and readmissions.
