Advertisement

Surgical Endoscopy

, Volume 27, Issue 9, pp 3406–3411 | Cite as

A nationwide examination of outcomes of percutaneous cholecystostomy compared with cholecystectomy for acute cholecystitis, 1998–2010

  • Jamie E. Anderson
  • David C. Chang
  • Mark A. Talamini
Article

Abstract

Background

Improvements in percutaneous drainage techniques combined with the recognized advantages of avoiding surgery in critically ill patients have rendered cholecystostomy an attractive treatment option, particularly in those patients with acute acalculus cholecystitis. However, robust data to guide surgeons in choosing cholecystostomy versus cholecystectomy have been lacking.

Methods

Retrospective analysis of the Nationwide Inpatient Sample (NIS) database from 1998–2010 was performed. Patients identified as having acute cholecystitis (calculus and acalculus) were identified by ICD-9 diagnosis codes and further classified as having undergone cholecystostomy or cholecystectomy. Patients with both procedures were included in the cholecystectomy group. Patients with neither procedure and those younger than age 18 years were excluded. Multivariate analyses examined mortality, length of stay, total charges, gallbladder/gastrointestinal complications, or any complication. Results were adjusted for age, race, gender, Charlson comorbidity index, and teaching-hospital status. Subset analyses were performed among patients who survived and patients who died.

Results

A total of 248,229 calculus and 58,518 acalculus acute cholecystitis patients were analyzed. On unadjusted analysis, mortality, length of stay, and total charges were higher, but complication rates were lower, in patients with a cholecystostomy. Adjusted analysis showed lower odds of complications [calculus: odds ratio (OR) 0.3, p < 0.001; acalculus: OR 0.4, p < 0.001] but higher odds of mortality, total charges, and LOS (calculus: mortality OR 5.2, p < 0.001, $29,113, p < 0.001, +5.1 days, p < 0.001; acalculus: mortality OR 3.7, p < 0.001; $43,771, p < 0.001, +6.2 days, p < 0.001) among patients who received cholecystostomy. Results were similar in subset analyses.

Conclusions

Patients receiving cholecystostomy were more likely to be older and have more comorbidities. Among patients with calculus or acalculus cholecystitis, patients with cholecystostomy had decreased complication rates compared with patients with cholecystectomy. However, patients who received cholecystostomy had increased odds of death, longer length of stay, and higher total charges.

Keywords

Cholecystectomy Cholecystostomy Cholecystitis Surgical outcomes 

Notes

Disclosures

Jamie Anderson, David Chang, and Mark Talamini have no conflicts of interest or financial ties to disclose. This research was unfunded.

References

  1. 1.
    Keus F, Gooszen HG, van Laarhoven CJ (2010) Open, small- incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane Hepato-Biliary Group reviews. Cochrane Database Syst Rev (1):CD008318Google Scholar
  2. 2.
    Pessaux P, Tuech JJ, Rouge C, Duplessis R, Cervi C, Arnaud JP (2000) Laparoscopic cholecystectomy in acute cholecystitis: A prospective comparative study in patients with acute vs chronic cholecystitis. Surg Endosc 14:358–361PubMedCrossRefGoogle Scholar
  3. 3.
    Winbladh A, Gullstrand P, Svanvik J, Sandstrom P (2009) Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB 11:183–193PubMedCrossRefGoogle Scholar
  4. 4.
    Agency for Healthcare Research and Quality (2011) Overview of the Nationwide Inpatient Sample (NIS). http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 2 March 2011
  5. 5.
    Bureau of Labor Statistics, US Department of Labor (2012) CPI inflation calculator. http://www.bls.gov/data/inflation_calculator.htm. Accessed 20 Dec 2012
  6. 6.
    Downing SR, Datoo G, Oyetunji TA, Fullum T, Chang DC, Ahuja N (2010) Asian race/ethnicity as a risk factor for bile duct injury during cholecystectomy. Arch Surg 8:785–787CrossRefGoogle Scholar
  7. 7.
    Charlson ME, Pompei P, Alex KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRefGoogle Scholar
  8. 8.
    Romano PS, Roos LL, Jollis JG (1993) Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 46:1075–1079 discussion 1081–1090PubMedCrossRefGoogle Scholar
  9. 9.
    Kalliafas S, Ziegler D, Flancbaum L, Choban PS (1998) Acute acalculous cholecystitis. Incidence, risk factors, diagnosis, and outcome. Am Surg 64:471–475PubMedGoogle Scholar
  10. 10.
    Laurila J, Syrjala H, Laurila PA, Saarnio J, Ala-Kokko TI (2004) Acute acalculous cholecystitis in critically ill patients. Acta Anaesthesiol Scand 48:986–991PubMedCrossRefGoogle Scholar
  11. 11.
    Chung YH, Choi ER, Kim KM, Kim MJ, Lee JK, Lee KT, Lee KH, Choo SW, Do YS, Choo IW (2011) Can percutaneous cholecystostomy be a definitive management for acute acalculus cholecystitis? J Clin Gastroenterol. doi: 10.1097/MCG.0b013e3182274375 Google Scholar
  12. 12.
    Ryu JK, Ryu KH, Kim KH (2003) Clinical features of acute acalculous cholecystitis. J Clin Gastroenterol 2:166–169CrossRefGoogle Scholar
  13. 13.
    Ganpathi IS, Diddapur RK, Eugene H, Karim M (2007) Acute acalculous cholecystitis: challenging the myths. HPB 9:131–134PubMedCrossRefGoogle Scholar
  14. 14.
    Kortram K, de Vries Reilingh TS, Wiezer MJ, van Ramshorst B, Boerma D (2011) Percutaneous drainage for acute calculous cholecystitis. Surg Endosc. doi: 10.1007/s00464-011-1771-5 PubMedGoogle Scholar
  15. 15.
    Byrne MF, Suhocki P, Mitchell RM, Pappas TN, Stiffler HL, Jowell PS, Branch MS, Baillie J (2003) Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center. J Am Coll Surg 197(2):206–211PubMedCrossRefGoogle Scholar
  16. 16.
    Nasim S, Khan S, Alvi R, Chaudhary M (2011) Emerging indications for percutaneous cholecystostomy for the management of acute cholecystitis—a retrospective review. Int J Surg 9:456–459PubMedCrossRefGoogle Scholar
  17. 17.
    McKay A, Abulfaraj M, Lipschitz J (2012) Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Surg Endosc 26:1343–1351PubMedCrossRefGoogle Scholar
  18. 18.
    Hatzidakis AA, Prassopoulos P, Petinarakis I, Sanidas E, Chrysos E, Chalkiadakis G, Tsiftsis D, Gourtsoyiannis NC (2002) Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment. Eur Radiol 12:1778–1784PubMedCrossRefGoogle Scholar
  19. 19.
    Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ (2001) Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc 15:700–705PubMedCrossRefGoogle Scholar
  20. 20.
    Kauvar DS, Brown BD, Braswell AW, Harnisch M (2005) Laparoscopic cholecystectomy in the elderly: increased operative complications and conversions to laparotomy. J Laparoendosc Adv Surg Tech A 15:379–382PubMedCrossRefGoogle Scholar
  21. 21.
    McGillicuddy EA, Schuster KM, Barre K, Suarez L, Hall MR, Kaml GJ, Davis KA, Longo WE (2012) Non-operative management of acute cholecystitis in the elderly. Br J Surg 99:1254–1261PubMedCrossRefGoogle Scholar
  22. 22.
    Bingener J, Richards ML, Schwesinger WH, Strodel WE, Sirinek KR (2003) Laparoscopic cholecystectomy for elderly patients: gold standard for golden years? Arch Surg 138:531–535PubMedCrossRefGoogle Scholar
  23. 23.
    Melloul E, Denys A, Demartines N, Calmes JM, Schafer M (2011) Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: does it matter? World J Surg 35:826–833PubMedCrossRefGoogle Scholar
  24. 24.
    Abi-Haidar Y, Sanchez V, Williams SA, Itani KMF (2012) Revisiting percutaneous cholecystostomy for acute cholecystitis based on a 10-year experience. Arch Surg 147(5):416–422PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jamie E. Anderson
    • 1
  • David C. Chang
    • 1
  • Mark A. Talamini
    • 1
  1. 1.Department of SurgeryUniversity of CaliforniaSan DiegoUSA

Personalised recommendations