Cholecystostomy tube management in acute cholecystitis: a population-based cohort study

The role of percutaneous transhepatic gallbladder drainage (PTGBD) in acute cholecystitis (AC) has been a subject of controversies lacking high-level of evidence. We set out to investigate clinical outcomes in patients admitted due to AC subjected to PTGBD with a cholecystostomy-free discharge. We hypothesized that AC recurrence and emergent readmission rates in patients undergoing early vs. delayed PTGBD tube removal are comparable and that AC recurrence risk following tube removal marginalizes over time.

After IRB approval, population-based cohort of PTGBD tubes placed and managed at all public healthcare facilities between 2010 and 2018 were retrospectively reviewed. Demographics and outcomes were accrued from hospital medical records and National Health and Welfare Systems digital database. Cholecystostomy removal was stratified into early (≤ 1 week) and delayed (> 1 week), respectively. The primary outcomes were AC recurrence and rehospitalization rates in early vs. delayed cholecystostomy tube removal and the progression of cumulative AC risk over time. The secondary outcomes included risk factors for recurrent AC following PTGBD.

Among 674 patients reviewed, 606 were discharged without index-admission cholecystectomy and in 583 cases, data on PTGBD indwelling time was available. Early vs. delayed tube removal resulted in comparable AC recurrence (17.7% vs. 19.5%, p = 0.602) and emergency readmission rates (27.5% vs. 28.1%, p = 0.884). There was a trend towards higher complication rate in delayed PTGBD removal group (7.9% vs. 12.8%, p = 0.065). Cumulative 1-year and 3-year risks for AC recurrence were 23.1% (95% CI: 18.9% - 28.1%) and 25.5% (95% CI: 21.0% - 30.9%), respectively.

In-hospital PTGBD tube removal within 1 week from placement was non-inferior to delayed removal in terms of AC recurrence or readmission rates. The cumulative risk of recurrent cholecystitis appears to plateau within the first year after PTGBD tube removal, with rare recurrences beyond this period.