Percutaneous cholecystostomy for grade III acute cholecystitis is associated with worse outcomes - 04/12/19

Doi : 10.1016/j.amjsurg.2019.11.025

Yas Sanaiha ^a, Yen-Yi Juo ^a, Sarah E. Rudasill ^a, Rakin Jaman ^a, Sohail Sareh ^a,^b, Christian de Virgilio ^b, Peyman Benharash ^a,^⁎
^a Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue Suite 62-249, Los Angeles, CA, 90095, USA
^b Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 42, Torrance, CA, 90502, USA

^∗Corresponding author. UCLA Division of Cardiac Surgery, 10833 Le Conte Avenue, UCLA Center for Health Sciences, Room 62-249, Los Angeles, CA, 90095, USA.UCLA Division of Cardiac SurgeryUCLA Center for Health Sciences10833 Le Conte AvenueRoom 62-249Los AngelesCA90095USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 04 December 2019

Abstract

Background

The aim of the present study was to evaluate the mortality, morbidity, and readmissions associated with management of grade 3 cholecystitis in the elderly, vulnerable population.

Methods

This was a retrospective cohort study of non-elective admissions for acute cholecystitis from 2010 to 2015 using the nationwide readmissions database for adults ≥ 65 years with evidence of end-organ dysfunction (grade 3) who underwent percutaneous cholecystostomy (PC), laparoscopic (LC) or open cholecystectomy (OC). Index and readmission outcomes were analyzed using logistic regression and inverse probability treatment weight analysis.

Results

Of the estimated 358,624 patients, 14.9% underwent PC, 15.7% OC, and 69.4% LC. PC had significantly higher odds of mortality (AOR 5.8, 95%CI 5.1–6.6), composite morbidity (AOR 3.8, 95%CI 3.5–4.1), early (AOR 1.9, 95%CI 1.7–2.0) and intermediate (AOR 2.2, 95%CI 2.0–2.5) readmission compared to LC and OC.

Conclusions

Patients undergoing cholecystostomy had higher mortality, complications, and readmission rates warranting revaluation of criteria for cholecystostomy at initial presentation.

Le texte complet de cet article est disponible en PDF.

Highlights

•	The rate of percutaneous cholecystostomy significantly increased from 2010 to 2015.
•	PC had higher odds of mortality, morbidity, and readmission compared to OC and LC.
•	PC was also associated with increased length of stay compared to LC.

Le texte complet de cet article est disponible en PDF.

Keywords : Percutaneous cholecystostomy, Cholecystectomy, Grade III cholecystitis, Nationwide readmissions database, Geriatric surgery

Abbreviations : PC, LC, OC, NRD, AHRQ, IPTW, LVH, HVH