Southwestern Surgical CongressEmergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study
Section snippets
Database description
The University HealthSystem Consortium (UHC) is an alliance of >100 academic medical centers and >250 of their affiliated hospitals, representing 90% of the nation's nonprofit academic medical centers. The UHC database is an administrative, clinical, and financial database that provides patient-level data for the purpose of comparative analysis between institutions. The UHC database contains discharge information on inpatient hospital stay, including patient characteristics, length of stay
Results
A total of 1,725 patients with major and extreme SOI were diagnosed with acalculous cholecystitis between October 2007 and June 2011. Of these, LC was attempted in 822 patients, OC in 199, and PC in 704.
Patients undergoing PC (n = 704) compared with LO (n = 1,021) showed decreased morbidity (5.0% with PC vs 8.0% with LO, P < .05), fewer ICU admissions (28.1% with PC vs 34.6% with LO, P < .05), decreased LOS (7 days with PC vs 8 days with LO, P < .05), and lower costs ($40,516 with PC vs $53,011
Comments
AAC in extremely ill patients poses significant challenges to their surgical management. Several procedural treatment options are available, making the need for evidence-based recommendation more critical.
In this study, we attempted to answer this question by looking at the perioperative outcomes of surgical management of AAC, available in a large retrospective administrative database, that of the UHC. As many studies have suggested before, LC is a safe and effective treatment for acute
Conclusions
On the basis of this experience, we conclude that extremely ill patients with AAC have superior outcomes with PC. For those patients in whom the risk for conversion is low and medical condition allows, LC should be performed. Our results show PC to be a safe and cost-effective bridge treatment strategy with superior perioperative outcomes compared with OC.
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Cited by (88)
Non-Traumatic Hepatobiliary Emergencies
2023, Surgical Clinics of North AmericaPercutaneous Cystic Duct Interventions and Drain Internalization for Calculous Cholecystitis in Patients Ineligible for Surgery
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2022, HeliyonCitation Excerpt :This can be a temporary solution or a treatment option. As it has been suggested by a large retrospective study, for selected patients, PC can have a lower morbidity, fewer intensive care unit admissions, a decreased length of stay, and lower costs compared with open cholecystectomy [11] with a low overall rate of complications (around 2%) [27]. In addition, higher mortality rates could be linked to their conditions and not directly to the PC.
Percutaneous Cholecystostomy
2020, Image-Guided Interventions: Expert Radiology Series, Third EditionCholecystostomy: Are we using it correctly?
2019, American Journal of SurgeryCitation Excerpt :Across the American population of approximately 330 million, 10–15% of adults have gallstones. Of these, 1–4% have symptomatic cholelithiasis, and of these 20% - an estimated 400,000 patients - develop acute complications.1–3 Cholecystectomy remains the standard of care for symptomatic or complicated cholelithiasis, with approximately 600,000 to 1.5 million cholecystectomies performed per year in the United States.
Percutaneous cholecystostomy as treatment for acute cholecystitis: What has happened over the last five years? A literature review
2019, Revista de Gastroenterologia de Mexico
The authors declare no conflicts of interest.