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Background: The standard of care for cholecystitis is cholecystectomy, however in high risk surgical patients the mortality rate from cholecystectomy can be as high as 18 to 30%. An alternative for this population is placement of a percutaneous transhepatic cholecystostomy which allows for cholecystectomy electively, under more stable conditions. The goal of this study was to evaluate cholecystostomy use at our institution, study predictors of success with this treatment in high risk patients, and study which patients were treated definitively with cholecystomy tube placement.
Methods: All patients who underwent cholecystostomy tube placement between 2007 and 2012 were included in this study. Electronic health records were retrospectively reviewed to delineate factors related to cholecystostomy failure based on two criteria: the need for cholecystectomy within 14 days of cholecystostomy placement or death within 30 days following cholecystostomy.
Results: Seventy-six patients (32 women, 42%) with a mean age of 67 years old (range: 24-94) underwent cholecystostomy during the study period. The patients had an average of three comorbid conditions. Overall, 53 (70%) patients treated with cholecystostomy experienced clinical success as defined above. Twenty-three patients (30%) underwent cholecystostomy tube placement that was a clinical failure. Of these, 6 patients (8% of the entire cohort) needed cholecystectomy within 14 days of cholecystostomy. Twenty patients (29% of the entire cohort) died within 30 days of the procedure (3 patients failed both criteria). A uni-variate analysis was performed to determine if there were certain patient characteristics that would predict cholecystostomy treatment failure but the only statistically significant indicators for risk of death within 30 days were intensive care unit (ICU) admission (p=0.001) and patients who had shock or sepsis (p=0.02). Other clinical factors did not prove to be predictive of success including comorbidities, method of presentation, imaging characteristics, antibiotic usage, bile cultures, and American Society of Anesthesiologists (ASA) physical status classification. Of the 76 total patients, 24 (31.6%) had a cholecystectomy an average of 66 days following cholecystostomy placement (Interquartile range: 19, 71). Of the 53 patients who experienced initial clinical success, 35 patients (66% of these patients) were definitively treated and did not need a cholecystectomy.
Conclusion: Percutaneous cholecystostomy remains a valuable tool to treat cholecystitis in high risk populations. This study illustrates that cholecystostomy tube placement can be the definitive treatment for acute cholecystitis in high risk populations. Further studies will be needed to delineate which patients will eventually need a cholecystectomy.