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COMPARATIVE ANALYSIS OF CHOLECYSTECTOMY VS. CHOLECYSTOSTOMY FOR THE MANAGEMENT OF ACUTE CHOLECYSTITIS IN ELDERLY PATIENTS
Francisco Schlottmann^*, Charles Gaber, Paula D. Strassle, Marco G. Patti, Anthony G. Charles
University of North Carolina, Chapel Hill, NC
Background: The progressing aging of the population will increase the number of elderly patients with acute cholecystitis. Data comparing outcomes following cholecystectomy and cholecystostomy tube placement (CTP) in these patients are lacking.

Aims: We aimed to compare the post-procedural outcomes and charges between cholecystectomy and CTP in elderly patients with acute cholecystitis.

Methods: We performed a retrospective population-based analysis using the National Inpatient Sample for the period 2000-2014. Patients ≥ 65 years old diagnosed with acute cholecystitis and who underwent either cholecystectomy or CTP during their inpatient hospitalization were included. Linear and logistic regression models were used to analyze post-procedural complications, mortality, and total charges. A subset analysis was performed to assess the effect of the procedure type among patients with acalculous and calculous cholecystitis. Models were adjusted for admission year, gender, race, comorbidities, primary insurance, household income, hospital region, hospital teaching status, and hospital size.

Results: A total of 278,642 patients were included, 263,265 underwent cholecystectomy and 15,377 CTP. The median age of patients undergoing cholecystectomy and CTP was 76 (IQR 70-82) and 80 (IQR 73-86), respectively (p<0.001). Patients undergoing CTP were more likely to have post-procedural infection (OR 3.94, 95% CI 3.78, 4.11), bleeding (OR 1.74, 95% CI 1.66, 1.82), cardiac failure (OR 2.44, 95% CI 2.34, 2.55), renal failure (OR 3.01, 95% CI 2.88, 3.15), respiratory failure (OR 2.22, 95% CI 2.10, 2.35), and inpatient mortality (OR 12.99, 95% CI 12.00, 14.06). On average, cholecystostomy patients stayed 3.38 days longer in hospital. There was an increase in charges of 26,250 dollars per case among patients undergoing CTP (Table 1). The benefits of surgical resection were similar across patients with acalculous and calculous cholecystitis (Table 2).

Conclusions: Elderly patients with both acalculous and calculous acute cholecystitis managed with CTP have higher rates of morbidity and mortality, longer length of hospital stay, and increased total charges, as compared to cholecystectomy. Unless prohibitive surgical risks, elderly patients with acute cholecystitis should undergo cholecystectomy.

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