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Changing Trends and Outcomes in the Use of Percutaneous Cholecystostomy Tubes for Acute Cholecystitis

Smith, Travis J. MD*; Manske, Jacob G. BS; Mathiason, Michelle A. MS; Kallies, Kara J. MS; Kothari, Shanu N. MD, FACS

doi: 10.1097/SLA.0b013e318274779c
Original Articles

Background: Percutaneous cholecystostomy tube (PCT) placement serves as a treatment option for acute cholecystitis in elderly and critically ill patients. The objective of this study was to compare PCT and cholecystectomy outcomes over time.

Methods: PCTs placed from April 1, 1998, to December 31, 2009 (time period 2) were retrospectively reviewed. Patients who underwent cholecystectomies served as matched controls. Institutional data from March 1, 1989, to March 31, 1998 (time period 1) were reviewed to compare trends.

Results: A total of 143 patients successfully underwent PCT placement in time period 2. When compared with patients undergoing cholecystectomy, PCT patients had a higher rate of cardiovascular disease (66% vs 26%, P = 0.001), diabetes (27% vs 13%, P = 0.001), and a higher mean Charlson comorbidity index (3.27 vs 1.07, P = 0.001). Compared with the first time period, patients undergoing PCT in the second time period had lower American Society of Anesthesiologist's classifications (American Society of Anesthesiologist's class I, II: 0% vs 18%, P = 0.001). Thirty-day mortality decreased from 36% to 12% in patients undergoing PCT (P = 0.001).

Conclusions: Among patients with acute cholecystitis, percutaneous cholecystostomy tubes were placed in older patients with increased comorbidities compared to cholecystectomy. Mortality rates after PCT decreased over time.

Percutaneous cholecystostomy tubes (PCT) are a treatment option for acute cholecystitis in high-risk patients. Over time, PCT has been used more frequently in patients with fewer comorbidities and fewer 30-day mortalities than cholecystectomy. Potential reasons for this change are multifactorial and may involve an increase in transparency of surgical outcomes.

*Departments of Medical Education

Research, Gundersen Medical Foundation

Department of General and Vascular Surgery, Gundersen Health System; La Crosse, WI.

Reprints: Shanu N. Kothari, MD, FACS, Department of General and Vascular Surgery, Gundersen Health System, 1900 South Avenue C05-001, La Crosse, WI. E-mail: snkothar@gundersenhealth.org.

Disclosure: The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.