Revisiting percutaneous cholecystostomy for acute cholecystitis based on a 10-year experience

摘要

Objectives: To identify patient characteristics leading to percutaneous cholecystostomy (PC) and to compare outcomes between PC and cholecystectomy (CCY) in patients with acute cholecystitis (AC). Design: Retrospective cohort study. Setting: Veterans Affairs Boston Healthcare System. Patients: All consecutive patients with AC per the Tokyo criteria who underwent PC or CCY from January 1, 2001, through December 31, 2010. Main Outcome Measures: Differences in baseline characteristics and outcomes between PC and CCY patients, odds of PC vs CCY use, and odds of death after PC or CCY. Results: Of 480 CCY and 92 PC procedures, 150 CCY and 51 PC procedures were performed for AC. The PC patients were older (70.4 vs 65.0 years, P=.01) and had higher leukocyte counts (16 500 vs 14 700/μL [to convert to ×10 9/L, multiply by 0.001], P=.046), alkaline phosphatase levels (198.2 vs 140.1 U/L [to convert to microkatals per liter, multiply by 0.0167], P=.02), Charlson comorbidity index scores (3.0 vs 1.0, P.001), and American Society of Anesthesiologists class (P=.006) compared with CCY patients. The PC patients had longer intensive care unit stays (5.9 vs 2.3 days, P=.008), longer hospital stays (20.7 vs 12.1 days, P.001), more complications per patient (2.9 vs 1.9, P=.01), and higher readmission rates (31.4% vs 13.3%, P=.006). On multivariate analysis, a Charlson comorbidity index score of 4 or higher was the only independent predictor of treatment with PC vs CCY (odds ratio, 1.226; 95% CI, 1.032- 1.457) and was the only independent predictor of death after PC or CCY (odds ratio, 1.318; 95% CI, 1.143- 1.521). No differences in survival were found between the PC and CCY groups (P=.14). Conclusion: Compared with CCY, PC is associated with higher morbidity rates and should be reserved for patients with prohibitive risks for surgery.