Management of Acute Cholecystitis: Prevalence of Percutaneous Cholecystostomy and Delayed Cholecystectomy in the Elderly

• Published in: Journal of gastrointestinal surgery 2014-02, Vol.18 (2), p.328-333
• Main Authors: Cull, John D., Velasco, Jose M., Czubak, Alexander, Rice, Dahlia, Brown, Eric C.
• Format: Article
• Language: English
• Subjects: 2013 SSAT Poster Presentation; Abdomen; Aged; Aged, 80 and over; Anastomotic Leak - etiology; APACHE; Cholangitis; Cholangitis - etiology; Cholecystectomy; Cholecystitis, Acute - complications; Cholecystitis, Acute - surgery; Cholecystostomy - adverse effects; Cholecystostomy - methods; Cholecystostomy - mortality; Conversion to Open Surgery; Female; Gallbladder diseases; Gastroenterology; Guideline Adherence; Humans; Intestines - injuries; Laparoscopy; Male; Medical personnel; Medical records; Medicine; Medicine & Public Health; Mortality; Pancreatitis; Pancreatitis - etiology; Patients; Practice Guidelines as Topic; Recurrence; Retrospective Studies; Surgeons; Surgery; Time Factors
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-013-2341-z

Background Published guidelines recommend early cholecystectomy for acute cholecystitis in the elderly. Alternatively, percutaneous cholecystostomy can be used in compromised patients. Methods We reviewed 806 elderly patients diagnosed with biliary disease retrospectively identified through billing and diagnosis codes. Two hundred sixty-five patients with histologically documented acute cholecystitis were selected. Results Initially, 75 patients had percutaneous cholecystostomy (Group 1), 64 (24 % underwent interval cholecystectomy, 74 (28 %) early (Group 2), and 127 (48 %) delayed cholecystectomy (Group 3). Group 1 was more likely to have American Society of Anesthesiologists (ASA) scores of 4 when compared to those in Groups 2 and 3 ( p  = 0.04). No difference existed among the groups when patients with an ASA of 4 were excluded: conversion rates (11 %), biliary leak, bowel injury, need for reoperation, or 30 days mortality. Patients in Group 1 and in Group 3 were five times ( p  = 0.04) and four times ( p  = 0.06) more likely, respectively, than those in Group 2 to have recurrent episodes of pancreatitis, cholecystitis, and cholangitis. Conclusion Patients were more likely to have delayed cholecystectomy after initial antibiotic therapy or cholecystostomy without the benefit of a lower conversion rate when compared to the early group, but they had higher recurrent episodes of cholecystitis/pancreatitis or cholangitis.