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Defining endpoints in percutaneous cholecystostomy: Catheter management, patient survival, and long-term outcomes
Maryam Hassanesfahani1, Dimitrios Giannis2, Nana Marfo1
1Department of Surgery, Flushing Hospital Medical Center, MediSys Health Network, Flushing, Queens, NY 11355, United States.
Insights
Early percutaneous cholecystostomy (PCT) significantly improves survival for high-risk acute cholecystitis patients. Delayed PCT increases mortality risk, underscoring the need for timely intervention and standardized care protocols.
Area of Science:
- Hepatobiliary surgery
- Interventional radiology
- Gastroenterology
Background:
- Percutaneous cholecystostomy (PCT) is a common treatment for high-risk acute cholecystitis, offering an alternative to immediate surgery.
- However, optimal timing, catheter management strategies, and long-term patient outcomes following PCT require further investigation.
Purpose of the Study:
- To evaluate the impact of timing for percutaneous cholecystostomy (PCT) placement on survival rates in high-risk acute cholecystitis patients.
- To characterize catheter management, survival, and follow-up outcomes in this patient cohort.
Main Methods:
- Retrospective cohort study of 174 adult patients with acute cholecystitis undergoing PCT between 2012 and 2024.
- Patients were analyzed based on timing of PCT (early ≤4 days vs. late >4 days), cholecystitis type, and intensive care unit (ICU) status.
- Cox proportional hazards models assessed the effect of PCT timing on mortality, controlling for covariates.
Main Results:
- Overall mortality was 21%. Delayed PCT (>4 days) was associated with significantly higher mortality (35%) compared to early PCT (≤4 days) (15%).
- Patients with late PCT had a 2.5-fold increased risk of death.
- High rates of long-term catheter dependency (55%) and interval cholecystectomy (32%) were observed.
Conclusions:
- Early percutaneous cholecystostomy (PCT) is associated with improved survival in patients with high-risk acute cholecystitis.
- The high incidence of catheter dependency highlights a need for standardized protocols and reassessment for definitive surgical management.
Background:
Percutaneous cholecystostomy (PCT) is widely used for high-risk acute cholecystitis as an alternative to emergent cholecystectomy. Despite its effectiveness, the optimal timing, catheter management, and long-term outcomes remain to be elucidated.
Aim:
To characterize timing, catheter management, survival, and follow-up outcomes after PCT in a high-risk cohort.
Methods:
This single center retrospective cohort study included consecutive adult patients undergoing PCT placement for acute cholecystitis at a community hospital setting in New York between January 2012 and December 2024. The study population was grouped according to type of acute cholecystitis (calculous vs acalculous), according to the timing of PCT placement since diagnosis [early (≤ 4 days) vs late (> 4 days)], and according to level of care [intensive care unit (ICU) vs non-ICU patients]. Cox proportional hazards models were used to examine effects of PCT placement interval on mortality rates, after accounting for potential confounding factors (age, Charlson Comorbidity Index, cholecystitis type, ICU status, bile culture and blood culture data).
Results:
The population consisted of 174 patients who underwent PCT placement for acute cholecystitis between 2012 and 2024 at a community hospital in New York. Median time to PCT was 2 days (interquartile range 1-4). Overall, mortality was 21% (36/174) and was higher with delayed PCT (> 4 days) vs early PCT [35% (17/49) vs 15% (19/125), P = 0.001]. Catheter removal occurred in 13% (23/174), 55% (96/174) remained catheter-dependent, and 32% (56/174) had interval cholecystectomy. ICU admission was associated with prolonged catheter duration but was not associated with mortality. Kaplan-Meier analysis demonstrated a significantly higher survival rate in the early group compared with the late group (log-rank P = 0.006). In both unadjusted models and models adjusted for selected covariates, patients who had catheters placed late (> 4 days) had 2.5-fold higher risk of death than patients with early placement.
Conclusion:
Early PCT was associated with higher survival in high-risk acute cholecystitis. High rates of catheter dependency highlight the need for standardized protocols and reassessment for definitive surgery.
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