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The Impact of Percutaneous Cholecystostomy Timing on Mortality and Morbidity in High-Risk Patients With Acute Calculous Cholecystitis
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DOI：10.1097/SLE.0000000000001431.png)
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Abstract
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Background: The optimal timing of percutaneous cholecystostomy (PC) in acute cholecystitis remains unclear, despite its increasing adoption as a treatment option for elderly and critically ill patients. This study aimed to evaluate the impact of PC timing on complications, hospital stay, and mortality in high-risk patients with moderate and severe acute calculous cholecystitis. Materials and Methods: Between 2020 and 2024, 124 consecutive patients who underwent PC were retrospectively reviewed. The time periods from admission to PC were measured. Patients with grade II cholecystitis who had a Charlson Comorbidity Index (CCI) score >= 6 and an American Society of Anesthesiologists Physical Status (ASA-PS) score >= 3, and those with grade III cholecystitis who had a CCI score >= 4 and an ASA-PS score >= 3, were defined as high-risk patients using TG18-aligned thresholds. Among these 82 high-risk patients, the median time from admission to PC was 39 hours (range: 21 to 62 h). Results: Early high-risk group (<= 48 h; n=51) had shorter hospital stay [7 (5 to 8) vs. 13 (6 to 20) d; P<0.001], lower <= 90-day mortality rate (5.9% vs. 22.6%; P=0.037) and lower <= 365-day mortality rate (7.8% vs. 25.8%; P=0.049) as compared with delayed high-risk group (>48 h; n=31). Delayed PC (OR=4.80, P=0.004) and complications related to PC (OR=4.37, P=0.015) were independent risk factors for longer hospital stay. A higher CCI Score (>= 7) (OR=13.68, P=0.047) and delayed PC (OR=8.64, P=0.04) were independent risk factors for in-hospital mortality. Conclusions: While emergency cholecystectomy remains the gold standard for the treatment of acute cholecystitis, PC represents a valuable initial treatment alternative in high-risk patients when performed at an early stage. Early PC provides significant advantages, including fewer complications, shorter hospitalization, and reduced in-hospital mortality.
Keywords:
percutaneous cholecystostomy
high-risk patients
early placement
length of hospital stay
mortality
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