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Percutaneous Cholecystostomy Tube for Acute Cholecystitis: Quantifying Outcomes and Prognosis
Raymond Huang1, Deven C Patel1, Joseph R Kallini2
1Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
The Journal of Surgical Research
|November 8, 2021
Summary
Percutaneous cholecystostomy tubes (PCT) are used for acute cholecystitis in non-surgical candidates. High mortality (31.9%) was observed, with bilirubin and complication risk predicting outcomes. Many survivors did not undergo interval cholecystectomy.
Area of Science:
- Interventional Radiology
- Surgical Oncology
- Gastroenterology
Background:
- Percutaneous cholecystostomy tubes (PCT) manage acute cholecystitis in patients unfit for surgery.
- Decision-making drivers and outcomes for PCT use require further study.
- This study characterizes PCT practices and outcomes at an urban medical center.
Purpose of the Study:
- To evaluate the utilization and outcomes of percutaneous cholecystostomy tubes (PCT).
- To identify predictors of 30-day mortality in patients undergoing PCT.
- To assess the rate of interval cholecystectomy after PCT placement.
Main Methods:
- Retrospective review of 204 patients undergoing PCT placement over 12 years.
- Abstraction of demographics, clinical data, imaging, and outcomes.
- Primary outcome: 30-day mortality; Secondary outcome: interval cholecystectomy.
Main Results:
- 30-day mortality was 31.9%, significantly higher in ICU patients (41.5%) vs. ward patients (18.6%).
- Among survivors, 76.3% had PCT removed, but only 39.6% underwent interval cholecystectomy.
- Elevated total bilirubin and higher NSQIP risk of serious complication predicted 30-day mortality.
Conclusions:
- Patients undergoing PCT have a high mortality risk.
- Despite PCT removal, interval cholecystectomy is infrequent among survivors.
- Total bilirubin and NSQIP risk are key predictors for 30-day mortality in PCT patients.
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