Outcomes of Percutaneous Cholecystostomy in the Management of Acute Cholecystitis: A Retrospective Cohort Study at a...

Background Percutaneous cholecystostomy is a recognized option for managing acute cholecystitis in high-risk surgical patients unsuitable for laparoscopic cholecystectomy. Tools such as the American Society of Anesthesiologists (ASA) grading and the Charlson Comorbidity Index (CCI) scoring are often used to suggest which patients would have better outcomes with percutaneous cholecystostomy. According to the literature, recurrence rates and leukocytosis reduction are key measures of cholecystostomy's clinical effectiveness in managing cholecystitis. Aims This study sought to evaluate clinical outcomes after percutaneous cholecystostomy in a rural district general hospital, specifically comparing outcomes for patients identified as being the best candidates for Percutaneous cholecystostomy (PC) according to the Tokyo Guidelines with outcomes for patients who received PC despite not being adherent to the criteria of the Tokyo Guidelines. Methods This was a retrospective cohort study. Sixty patients underwent PC for acute cholecystitis in a single rural district general hospital between October 2019 and January 2024. Data collection was carried out on clinical information systems to gather relevant variables such as patient demographics, blood results, comorbidities, complications, and length of stay in the hospital. Results Sixty patients underwent cholecystostomy during the study, with data available for 58 (96.7%). Of these, 21 (36.2%) were female. The mean age was 74±10.5. The average ASA was 2.9, and the average CCI was 6.0. Of all patients who underwent a cholecystostomy, there was a technical success rate of 100%. Of the 48 (82.8%) patients with a leukocytosis on the day of procedure, 48% (n=21) experienced resolution of leukocytosis 48-72 hours postoperatively. The average reduction in white cell count from the day of procedure to 48-72 hours post-operatively was 36.8% (p= 0.002 × 10^-5). There was a non-fatal complication rate of 31% (n=18) and the 30-day mortality rate was 5.1% (n=3). Of the patients who underwent PC, 35% (n=20) later went on to receive laparoscopic cholecystectomy. Conclusion PC has been shown to be an effective procedure in the management of acute cholecystitis in patients identified as high-risk using ASA grading and CCI scoring.