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Percutaneous Cholecystostomy in Acute Cholecystitis-Predictors of Recurrence and Interval Cholecystectomy.

Publication ,  Journal Article
Bhatt, MN; Ghio, M; Sadri, L; Sarkar, S; Kasotakis, G; Narsule, C; Sarkar, B
Published in: J Surg Res
December 2018

BACKGROUND: Percutaneous cholecystostomy (PC) tube is a preferred option in acute cholecystitis for patients who are high risk for cholecystectomy (CCY). There are no evidence-based guidelines for patient care after PC. We identified the predictors of disease recurrence and successful interval CCY. METHODS: A retrospective review of 145 PC patients between 2008 and 2016 at a tertiary hospital was performed. Primary outcomes included mortality, readmissions, hospital and intensive care unit length of stay (LOS), disease recurrence, and interval CCY. RESULTS: There were 96 (67%) calculous and 47 (33%) acalculous cholecystitis cases. Seventy-two (49%) had chronic and 73 (51%) had acute prohibitive risks as an indication for PC. There were 54 (37%) periprocedural complications, which most commonly were dislodgements. Twenty-six (18%) patients had a recurrence at a median time of 65 days. Calculous cholecystitis (odds ratio [OR] 3.44, P = 0.038) and purulence in the gallbladder (OR 3.77, P = 0.009) were predictors for recurrence. Forty-one (28%) patients underwent interval CCY. Patients with acute illness were likely to undergo interval CCY (OR 6.67, P = 0.0002). Patients with acalculous cholecystitis had longer hospital LOS (16 versus 8 days) and intensive care unit LOS (2 versus 0 days), and higher readmission rates (OR 2.42, P = 0.02). Thirty-day mortality after PC placement was 9%. Patients receiving interval CCY were noted to have increased survival compared to PC alone. However, this should not be attributed to interval CCY alone in absence of randomization in this study. CONCLUSIONS: Calculous cholecystitis and purulence in the gallbladder are independent predictors of acute cholecystitis recurrence. Acute illness is a strong predictor of successful interval CCY. The association of interval CCY and prolonged survival in patients with PC as noted in this study should be further assessed in future prospective randomized trials.

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Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

December 2018

Volume

232

Start / End Page

539 / 546

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Recurrence
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
  • Female
  • Cholecystostomy
 

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Bhatt, M. N., Ghio, M., Sadri, L., Sarkar, S., Kasotakis, G., Narsule, C., & Sarkar, B. (2018). Percutaneous Cholecystostomy in Acute Cholecystitis-Predictors of Recurrence and Interval Cholecystectomy. J Surg Res, 232, 539–546. https://doi.org/10.1016/j.jss.2018.06.051
Bhatt, Maunil N., Michael Ghio, Lili Sadri, Srawani Sarkar, George Kasotakis, Chaitan Narsule, and Bedabrata Sarkar. “Percutaneous Cholecystostomy in Acute Cholecystitis-Predictors of Recurrence and Interval Cholecystectomy.J Surg Res 232 (December 2018): 539–46. https://doi.org/10.1016/j.jss.2018.06.051.
Bhatt MN, Ghio M, Sadri L, Sarkar S, Kasotakis G, Narsule C, et al. Percutaneous Cholecystostomy in Acute Cholecystitis-Predictors of Recurrence and Interval Cholecystectomy. J Surg Res. 2018 Dec;232:539–46.
Bhatt, Maunil N., et al. “Percutaneous Cholecystostomy in Acute Cholecystitis-Predictors of Recurrence and Interval Cholecystectomy.J Surg Res, vol. 232, Dec. 2018, pp. 539–46. Pubmed, doi:10.1016/j.jss.2018.06.051.
Bhatt MN, Ghio M, Sadri L, Sarkar S, Kasotakis G, Narsule C, Sarkar B. Percutaneous Cholecystostomy in Acute Cholecystitis-Predictors of Recurrence and Interval Cholecystectomy. J Surg Res. 2018 Dec;232:539–546.
Journal cover image

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

December 2018

Volume

232

Start / End Page

539 / 546

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Recurrence
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
  • Female
  • Cholecystostomy