A propensity score matched comparison of readmissions and cost of laparoscopic cholecystectomy vs percutaneous cholecystostomy for acute cholecystitis

Fleming, Matthew R; DeWane, Michael P.; Luo, Jiajun; Liu, Fangfang; Zhang, Yawei; Pei, Kevin Y.

doi:10.1016/j.amjsurg.2018.10.047

Cited by 15 publications

(11 citation statements)

References 35 publications

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“…[23][24][25][26][27][28] Other studies have also reported that emergent LC was superior to percutaneous transhepatic gallbladder drainage (PTGBD) in terms of cost-effectiveness, mortality, morbidity, length of hospital stay, and readmission, even in elderly high-risk patients who were conventionally thought to be good indicators of PTGBD. [29][30][31][32][33] Moreover, it was suggested that bile duct injury was more frequent in LC after PTGBD than in emergent LC. 34 Therefore, for severity grade II AC, TG18 recommends that "Lap-C should ideally be performed soon after onset if the CCI and ASA-PS scores suggest the patient can withstand surgery and the patient is in an advanced surgical centre."…”

Section: Discussionmentioning

confidence: 99%

Preoperative risk factors for technical difficulty in emergent laparoscopic cholecystectomy for acute cholecystitis

Ohya

Maeda

Takayama

et al. 2021

Asian J Endoscop Surgery

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Aim: We have routinely performed emergent laparoscopic cholecystectomy (LC) as soon as we diagnosed acute cholecystitis (AC), if patients could tolerate surgery. This study was conducted to identify the preoperative risk factors that predict the technical difficulty of emergent LC for AC.Methods: A retrospective review of patients with AC who underwent emergent LC between 2012 and 2019 was conducted. Technical difficulty was defined as the presence of the following conditions: open conversion, operative time ≥120 min, or blood loss ≥500 ml.Results: In all, 327 patients were included and divided into difficult LC (DLC, n = 61) and nondifficult LC (non-DLC, n = 266). Multivariate logistic analysis revealed that symptom duration ≥72 h was the only independent risk factor for DLC. Comparison of late LC (beyond 72 h, LLC) and early LC (within 72 h, ELC) showed a lower rate of creation of the critical view of safety and a longer hospital stay, as well as a longer operative time, a larger amount of bleeding, and a higher open conversion rate in LLC. However, the postoperative complication rates were equivalent.Conclusion: LC for AC with symptom duration ≥72 h tends to be technically difficult. However, it is acceptable regarding operative outcomes.

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Section: Discussionmentioning

confidence: 99%

Preoperative risk factors for technical difficulty in emergent laparoscopic cholecystectomy for acute cholecystitis

Ohya

Maeda

Takayama

et al. 2021

Asian J Endoscop Surgery

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“…This coincides with previous studies demonstrating that PCT placement is associated with increased morbidity and mortality compared to cholecystectomy. 14 Therefore, we believe PCT placement should be reserved for patients who will not get a cholecystectomy and do not respond to medical management. Alternatively, multiple authors have suggested that if there is clinical suspicion that PCT placement will occur, earlier placement is optimal 3 because delayed placement is associated with increased LOS and progression of the inflammatory process leading to the increased difficulty of any subsequent gallbladder surgery.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Cholecystostomy Tubes versus Medical Management for Acute Cholecystitis

Cook

Karim

Jensen

et al. 2021

The American Surgeon

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Background Cholecystitis is one of the most common infections treated surgically in the United States. Surgical risk is prohibitive in some patients, leading to alternative therapeutic strategies, including medical management (antibiotics) with or without percutaneous cholecystostomy tube (PCT) drainage. Materials and methods Using the Healthcare Cost and Utilization Project (HCUP) National Readmission Database (NRD), we performed a retrospective review to compare medically managed patients with or without PCT placement by evaluating 60-day readmissions rates, health care costs, and hospital length of stay (LOS). Both study groups were matched using the Elixhauser comorbidity index, age, and sex. Univariate and multivariate statistical analyses were performed using STATA. Results 776,766 patients were included in the analysis. The population receiving PCT placement was on average 16 years older (69.9 vs 53.6 years; P < .01), less likely to be female (40.7% vs 59.3%; P < .01), and had almost twice as many comorbidities (3.36 vs 1.81; P < .01) compared to the population receiving medical management. After matching our data to account for these incongruities, PCT patients were still 10.4 times more likely to be readmitted, had a 11.6% increase in the cost of care, and a 37.6% increase in LOS compared to those managed medically. Discussion Percutaneous cholecystostomy tube placement for cholecystitis is associated with a higher readmission rate, increased charges, and increased LOS compared to antibiotic therapy alone, even after correcting for age, sex, and comorbidities.

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“…TG18 advocates definitive surgical intervention (usually laparoscopic cholecystectomy) on the index admission in patients with acute cholecystitis or biliary pancreatitis, citing both prospective longitudinal studies and retrospective observational studies that demonstrated a significantly lower incidence of disease recurrence, hospital readmission, and overall disease-specific complications when the procedure was performed within 7 days of the onset of symptoms in the appropriate patient (recommending within 72 h as preferable) 5,17,[23][24][25][26][27][28][29][30] . However, 15 (60 per cent) of the 25 centres in the present study estimated that less than half of their patients routinely had index admission cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

Self-reported and actual adherence to the Tokyo guidelines in the European snapshot audit of complicated calculous biliary disease

et al. 2020

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Background: Complicated acute biliary calculous disease poses clinical challenges. The European Society of Trauma and Emergency Surgery (ESTES) snapshot audit of complicated biliary calculous disease aims to make novel comparisons between self-reported institutional adherence to the Tokyo guidelines (TG18) and 'real-world' contemporary practice across Europe. Methods: A preplanned analysis of a prospective observational multicentre audit that captured patients undergoing emergency admission for complicated biliary calculous disease (complicated cholecystitis, biliary pancreatitis, or choledocholithiasis with or without cholangitis) between 1 and 31 October 2018 was performed. An anonymized survey was administered to participating sites. Results: Following an open call for participation, 25 centres from nine countries enrolled 338 patients. All centres completed the anonymized survey. Fifteen centres (60 per cent) self-reported that a minority of patients were treated surgically on index admission, favouring interval cholecystectomy. This was replicated in the snapshot audit, in which 152 of 338 patients (45⋅0 per cent) underwent index admission cholecystectomy, 17 (5⋅0 per cent) had interval cholecystectomy, and the remaining 169 (50⋅0 per cent) had not undergone surgery by the end of the 60-day follow-up. Centres that employed a dedicated acute care surgery model of care were more likely to perform index admission cholecystectomy compared with a traditional general surgery 'on call' service (57 versus 38 per cent respectively; odds ratio 2⋅14 (95 per cent c.i. 1⋅37 to 3⋅35), P < 0⋅001). Six centres (24 per cent) self-reported routinely performing blood cultures in acute cholecystitis; patient-level audit data revealed that blood cultures were done in 47 of 154 patients (30⋅5 per cent). No centre self-reported omitting antibiotics in the management of acute cholecystitis, and 144 of 154 (93⋅5 per cent) of patients in the snapshot audit received antibiotics during their index admission. Conclusion: Awareness of TG18 recommendations was high, but self-reported adherence and objective snapshot audit data showed low compliance with TG18 in patients with complicated acute biliary calculous disease. Funding information No funding * Members of the ESTES Cohort Studies Group are co-authors of this study and may be found under the heading Collaborators.

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A propensity score matched comparison of readmissions and cost of laparoscopic cholecystectomy vs percutaneous cholecystostomy for acute cholecystitis

Cited by 15 publications

References 35 publications

Preoperative risk factors for technical difficulty in emergent laparoscopic cholecystectomy for acute cholecystitis

Preoperative risk factors for technical difficulty in emergent laparoscopic cholecystectomy for acute cholecystitis

Percutaneous Cholecystostomy Tubes versus Medical Management for Acute Cholecystitis

Self-reported and actual adherence to the Tokyo guidelines in the European snapshot audit of complicated calculous biliary disease

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