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Cholecystostomy tube management in acute cholecystitis: a population-based cohort study
Arvo Reinsoo1,2, Ülle Kirsimägi3, Liis Kibuspuu4,5
1Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre Foundation, Tallinn, Estonia. arvo.reinsoo@gmail.com.
Insights
Early removal of percutaneous transhepatic gallbladder drainage (PTGBD) tubes is as effective as delayed removal for preventing acute cholecystitis (AC) recurrence and readmissions. The risk of AC recurrence plateaus within one year post-removal.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Surgical Outcomes
Background:
- Percutaneous transhepatic gallbladder drainage (PTGBD) is used for acute cholecystitis (AC), but evidence on optimal tube management is limited.
- Controversies exist regarding the best timing for PTGBD tube removal, impacting patient outcomes.
- This study addresses the lack of high-level evidence on early versus delayed PTGBD tube removal in AC patients discharged without cholecystectomy.
Purpose of the Study:
- To compare clinical outcomes, specifically AC recurrence and readmission rates, between early and delayed PTGBD tube removal.
- To evaluate the long-term risk of AC recurrence following PTGBD tube removal.
- To identify risk factors for recurrent AC after PTGBD.
Main Methods:
- Retrospective review of a population-based cohort of PTGBD procedures from 2010-2018.
- Data collected from hospital records and national databases.
- Stratification of tube removal into early (≤1 week) and delayed (>1 week) groups to assess primary outcomes (AC recurrence, rehospitalization) and secondary outcomes (risk factors).
Main Results:
- Early vs. delayed PTGBD tube removal showed comparable AC recurrence rates (17.7% vs. 19.5%) and emergency readmission rates (27.5% vs. 28.1%).
- A trend towards higher complication rates was observed in the delayed removal group (12.8% vs. 7.9%).
- Cumulative 1-year and 3-year AC recurrence risks were 23.1% and 25.5%, respectively, suggesting a plateau.
Conclusions:
- In-hospital PTGBD tube removal within one week is non-inferior to delayed removal for AC recurrence and readmission.
- The cumulative risk of recurrent cholecystitis appears to stabilize within the first year after PTGBD tube removal.
- Recurrences beyond the first year post-PTGBD tube removal are infrequent.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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