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Prognostic Factors and Predictive Models for Rates of Mortality and Morbidity Following Percutaneous Cholecystostomy:
Yicheng Wei1, Dhruvesh M Ramson1, Julian A Smith2
1Department of General Surgery, Middlemore Hospital, Auckland, New Zealand.
Insights
Percutaneous cholecystostomy offers a temporary solution for acute cholecystitis, but patients face significant long-term risks including high mortality and complications. Definitive treatment like interval cholecystectomy is crucial for better outcomes.
Area of Science:
- Hepatobiliary surgery
- Interventional radiology
- Gastroenterology
Background:
- Percutaneous cholecystostomy (PC) is vital for acute cholecystitis in non-surgical candidates.
- Long-term outcomes and mortality predictors for PC are not well-defined.
- This study evaluates PC outcomes and prognostic factors in New Zealand's largest single-centre cohort.
Purpose of the Study:
- To assess the long-term outcomes of percutaneous cholecystostomy.
- To identify key predictors of mortality and morbidity after PC.
- To inform patient counseling and treatment strategies.
Main Methods:
- Retrospective cohort study of 115 patients undergoing PC (2022-2024).
- Analysis of clinical, radiological, and procedural variables.
- Primary outcomes: 30-day, 90-day, and 1-year mortality. Secondary outcomes: sepsis resolution, readmissions, complications, and subsequent cholecystectomy.
Main Results:
- 1-year mortality was 25.2%; acute acalculous cholecystitis significantly increased mortality risk.
- Acute kidney injury predicted early mortality; cardiovascular comorbidities predicted late mortality.
- Sepsis resolved in 81.7% of cases, but readmissions and drain complications exceeded 50%.
Conclusions:
- PC patients have a high disease burden, with significant complications and late mortality.
- PC should be viewed as a temporizing measure, not definitive treatment.
- Interval cholecystectomy is essential for definitive management; address systemic illness in acalculous cholecystitis.
Background:
Percutaneous cholecystostomy is a critical intervention for patients with acute cholecystitis who are unsuitable for immediate surgery, yet long-term outcomes and prognostic indicators remain poorly defined. This largest single-centre study in New Zealand has been performed to evaluate percutaneous cholecystotomy outcomes and to investigate key predictors of mortality and morbidity.
Methods:
A retrospective cohort study of all patients undergoing percutaneous cholecystostomy between January 2022 and December 2024 was performed. Clinical, radiological and procedural variables were analysed. Primary outcomes were 30-day, 90-day and 1-year mortality; secondary outcomes included sepsis resolution, readmissions, drain-related complications and subsequent completion cholecystectomy.
Results:
Among 115 patients, mortality was 7.8% at 30 days, 11.3% at 90 days and 25.2% at 1 year. Acute acalculous cholecystitis conferred a fourfold greater 1-year mortality compared with calculous disease. Acute kidney injury predicted early mortality, while cardiovascular comorbidities predicted late mortality. Sepsis resolved within 72 h in 81.7% of patients, though after-hours procedures were associated with lower success rates. Readmissions and drain-related complications occurred in over half of patients.
Conclusions:
Patients undergoing percutaneous cholecystostomy face a substantial disease burden, with high rates of complications, readmissions and late mortality. Percutaneous cholecystostomy should be framed as a palliative or temporising measure rather than definitive therapy and patients must be counselled accordingly so expectations are realistic. In suitable candidates, interval cholecystectomy remains essential for definitive treatment. In acute acalculous cholecystitis, percutaneous cholecystostomy should not be the main treatment; priority must instead be given to addressing the underlying systemic illness.
