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Non-operative management of cirrhotic patients with acute calculous cholecystitis: How effective is it?

Kamil Hanna1, Bardiya Zangbar1, Jordan Kirsch1

  • 1Department of Surgery, Westchester Medical Center, New York, USA.

American Journal of Surgery
|July 23, 2023
PubMed

Insights

Nonoperative management (NOM) for acute calculous cholecystitis (ACC) in cirrhosis patients has a high failure rate. Percutaneous cholecystostomy (PCT) was linked to increased mortality and longer hospital stays compared to cholecystectomy.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Surgical Outcomes

Background:

  • Acute calculous cholecystitis (ACC) presents significant challenges in patients with cirrhosis.
  • Nonoperative management (NOM) has been proposed as an alternative to surgery for ACC in this population.
  • Evaluating the safety and efficacy of NOM versus surgical intervention is crucial for cirrhotic patients.

Purpose of the Study:

  • To compare the outcomes of cirrhotic patients with ACC treated with cholecystectomy versus NOM.
  • To analyze the effectiveness of different NOM strategies, including percutaneous cholecystostomy (PCT) and antibiotics alone.

Main Methods:

  • Analysis of the 2017 Nationwide Readmissions Database.
  • Inclusion of cirrhotic patients diagnosed with ACC.
  • Stratification of patients into three groups: cholecystectomy, PCT, and antibiotics only.

Main Results:

  • A total of 3454 patients were identified. Cholecystectomy was performed on 1832, PCT on 360, and antibiotics alone on 1262.
  • PCT group exhibited higher mortality (16.9%) compared to the antibiotics group (10.9%) and cholecystectomy group (4.2%).
  • NOM failure occurred in 28.2% of patients, associated with longer length of stay (LOS) and higher mortality, particularly with PCT.

Conclusions:

  • ACC is a severe condition in cirrhosis patients, with NOM failure rates approaching one-third.
  • Percutaneous cholecystostomy (PCT) is associated with increased mortality in this cohort.
  • Further research is needed to identify predictors of NOM failure in cirrhotic patients with ACC.
Abstract

Keywords:
CholecystectomyLiver cirrhosisPercutaneous cholecystostomy

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