Percutaneous Cholecystostomy Tubes versus Medical Management for Acute Cholecystitis

Abstract

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.

Relationship between the Tokyo Guidelines and Pathological Severity in Acute Cholecystitis

“…Laparoscopic cholecystectomy is the treatment of choice for AC [ 12 , 13 ]. The surgical risk of the cholecystectomy itself is relatively low, but if the patient is unstable, percutaneous cholecystostomy can be performed, or surgery can be delayed [ 14 ]. For low-risk patients, early surgery is recommended, as a cholecystectomy can be safely performed within 48–72 h of disease onset, during the congestive or edematous phase.…”

Ultrasound-Guided Interventions in the Biliary System

“…The results can hardly be compared [52][53][54][55][56][57][58][59][60][61]. In general, patients receiving PGBD have more comorbidities or critical illnesses than the ones allocated for surgery [54,62] or for conservative treatment [63], most probably contributing to the higher complication rates.…”

“…Not included in the recommendations in the guidelines, antibiotics alone, simple (repeated) aspiration, and observation only are other treatment options [62,63,65,[68][69][70][71][72].…”

Acute Cholecystitis Diagnosis in the Emergency Department: An Artificial Intelligence-based Approach

“…It has been reported that 20% of patients admitted with biliary diseases have acute cholecystitis [1]. It is one of the most common complaints of all emergency department (ED) visits and occurs in 3-10% of patients with acute abdominal pain present in the ER [2].…”