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Current Trends and Effectiveness in Percutaneous Cholecystostomy Tube Utilization
Kai Zhao*, Joseph Kim, Dana A. Telem, Jie Yang, Mark A. Talamini, Purvi Parikh
Surgery, SUNY Stony Brook, Coram, NY
Background
Cholecystectomy is indicated for patients with acute cholecystitis. However, morbidity for emergent cholecystectomy may be exceedingly high in critically ill patients, therefore prompting management by percutaneous cholecystostomy. Data pertaining to the definitive treatment of patients following cholecystostomy is limited. We aim to determine current treatment strategies and outcomes.
Methods
Data were extracted from the New York State (NYS) Statewide Planning and Research Cooperation System (SPARCS) database for patients who were treated with percutaneous cholecystostomy tube from 1995 to 2013. We examined subsequent medical and surgical management including cholecystectomy, repeat cholecystostomy tube placement, or no further intervention. Data were extracted for pattern of treatment and was examined to determine potential correlations between patient characteristics and the treatment received. Chi-square test was used to compare categorical variables and Welch’s test was used to compare continuous variable.
Results
During the study period, 2492 percutaneous cholecystostomy tube procedures were performed on 2465 patients. In this cohort, 129 (5.2%) patients died after cholecystostomy during the same hospitalization; 1316 (53.4%) patients had cholecystectomy; 989 (40.1%) patients had no further intervention and were discharged. 19 patients had repeat percutaneous cholecystostomy without cholecystectomy while 7 patients had repeat percutaneous cholecystostomy followed by cholecystectomy. For patients who had cholecystectomy, the mean interval to surgery was 105 days. Utilization of cholecystostomy tube has significantly increased over the years. During this study period, percentage of patients who received no further treatment after cholecystostomy tube placement significantly increased.
Conclusion
Percutaneous cholecystostomy remains an effective treatment in management of acute cholecystitis in the critically ill patients. However, 40% patients with cholecystostomy did not receive subsequent cholecystectomy, raising the question whether there is over utilization of cholecystostomy tube. Further research needs to be performed for clear indications for cholecystostomy tube.
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