Skip to main content

Advertisement

SpringerLink
Log in

Percutaneous cholecystostomy: prognostic factors and comparison to cholecystectomy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Data regarding long-term outcomes following percutaneous cholecystostomy (PC) are limited, and comparisons to cholecystectomy (CCY) are lacking. We hypothesized that chronic disease burden would predict 1-year mortality following PC, and that outcomes following PC and CCY would be similar when controlling for preprocedural risk factors.

Methods

We performed a 10-year retrospective cohort analysis of patients with acute cholecystitis managed by PC (n = 114) or CCY (n = 234). Treatment response was assessed by systemic inflammatory response syndrome (SIRS) criteria at PC/CCY and 72 h later. Logistic regression identified predictors of 30-day and 1-year mortality following PC. PC and CCY patients were matched by age, Tokyo Guidelines (TG13) cholecystitis severity grade, and VASQIP calculator predicted mortality (n = 42/group).

Results

The presence of SIRS at 72 h following PC was associated with 30-day mortality [OR 8.9 (95% CI 2.6–30)]. SIRS at 72 h was present in and 21.4% of all PC patients, significantly higher than unmatched CCY patients (4.7%, p = 0.048). Independent predictors of 1-year mortality following PC were DNR status [19.7 (2.1–186)], disseminated cancer [7.5 (2.1–26)], and congestive heart failure [3.9 (1.4–11)]. PC patients with none of these risk factors had 17.9% 90-day mortality and no deaths after 90 days; late deaths continued to occur among patients with DNR, CHF, or disseminated cancer. At baseline, PC patients had greater acute and chronic disease burden than CCY patients. After matching, PC and CCY patients had similar age (69 vs. 70 years), TG13 grade (2.4 vs. 2.4), and predicted 30-day mortality (5.5 vs. 6.8%). Matched PC patients had higher 30-day mortality (14.3 vs. 2.4%, p = 0.109) and 180-day mortality (28.6 vs. 7.1%, p = 0.048).

Conclusions

Treatment response to PC predicted 30-day mortality; DNR status, and chronic diseases predicted 1-year mortality. Although the matching procedure did not eliminate selection bias, PC was associated with persistent systemic inflammation and higher long-term mortality than CCY.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Gurusamy KS, Rossi M, Davidson BR (2013) Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database Syst Rev 8:CD007088

    Google Scholar 

  2. Winbladh A, Gullstrand P, Svanvik J, Sandstrom P (2009) Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB 11:183–193

    Article  PubMed  PubMed Central  Google Scholar 

  3. Duszak R Jr, Behrman SW (2012) National trends in percutaneous cholecystostomy between 1994 and 2009: perspectives from medicare provider claims. J Am Coll Radiol 9:474–479

    Article  PubMed  Google Scholar 

  4. Patel PP, Daly SC, Velasco JM (2015) Training vs practice: a tale of opposition in acute cholecystitis. World J Hepatol 7:2470–2473

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cull JD, Velasco JM, Czubak A, Rice D, Brown EC (2014) Management of acute cholecystitis: prevalence of percutaneous cholecystostomy and delayed cholecystectomy in the elderly. J Gastrointest Surg 18:328–333

    Article  PubMed  Google Scholar 

  6. Kamalapurkar D, Pang TC, Siriwardhane M, Hollands M, Johnston E, Pleass H, Richardson A, Lam VW (2015) Index cholecystectomy in grade II and III acute calculous cholecystitis is feasible and safe. ANZ J Surg 85:854–859

    Article  PubMed  Google Scholar 

  7. Strasberg SM, Pucci MJ, Brunt LM, Deziel DJ (2016) Subtotal cholecystectomy-"fenestrating” vs “reconstituting” subtypes and the prevention of bile duct injury: definition of the optimal procedure in difficult operative conditions. J Am Coll Surg 222:89–96

    Article  PubMed  Google Scholar 

  8. Davies MG, Hagen PO (1997) Systemic inflammatory response syndrome. Br J Surg 84:920–935

    Article  CAS  PubMed  Google Scholar 

  9. Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Gouma DJ, Garden OJ, Buchler MW, Kiriyama S, Kimura Y, Tsuyuguchi T, Itoi T, Yoshida M, Miura F, Yamashita Y, Okamoto K, Gabata T, Hata J, Higuchi R, Windsor JA, Bornman PC, Fan ST, Singh H, de Santibanes E, Kusachi S, Murata A, Chen XP, Jagannath P, Lee S, Padbury R, Chen MF, Tokyo Guidelines Revision C (2012) New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci 19:578–585

    Article  PubMed  PubMed Central  Google Scholar 

  10. (2007) Tokyo Guidelines for the management of acute cholangitis and cholecystitis. Proceedings of a consensus meeting, April 2006 Tokyo, Japan. J Hepatobiliary Pancreat Surg 14: 1–121

  11. Mayumi T, Takada T, Kawarada Y, Nimura Y, Yoshida M, Sekimoto M, Miura F, Wada K, Hirota M, Yamashita Y, Nagino M, Tsuyuguchi T, Tanaka A, Gomi H, Pitt HA (2007) Results of the Tokyo Consensus Meeting Tokyo Guidelines. J Hepatobiliary Pancreat Surg 14:114–121

    Article  PubMed  PubMed Central  Google Scholar 

  12. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, STROBE Initiative (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4:e296

    Article  Google Scholar 

  13. Carter JV, Pan J, Rai SN, Galandiuk S (2016) ROC-ing along: evaluation and interpretation of receiver operating characteristic curves. Surgery 159(6):1638–1645

    Article  PubMed  Google Scholar 

  14. Lusted LB (1971) Signal detectability and medical decision-making. Science 171:1217–1219

    Article  CAS  PubMed  Google Scholar 

  15. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  CAS  PubMed  Google Scholar 

  16. McCloskey CA, Wilson MA, Hughes SJ, Eid GM (2007) Laparoscopic colorectal surgery is safe in the high-risk patient: a NSQIP risk-adjusted analysis. Surgery 142: 594–597. discussion 597 e591–592

    Article  PubMed  Google Scholar 

  17. Dwyer JG, Reynoso JF, Seevers GA, Schmid KK, Muralidhar P, Konigsberg B, Lynch TG, Johanning JM (2014) Assessing preoperative frailty utilizing validated geriatric mortality calculators and their association with postoperative hip fracture mortality risk. Geriatr Orthop Surg Rehabil 5:109–115

    Article  PubMed  PubMed Central  Google Scholar 

  18. Johnson MS, Bailey TL, Schmid KK, Lydiatt WM, Johanning JM (2014) A frailty index identifies patients at high risk of mortality after tracheostomy. Otolaryngol Head Neck Surg 150:568–573

    Article  PubMed  Google Scholar 

  19. Afshar AH, Virk N, Porhomayon J, Pourafkari L, Dosluoglu HH, Nader ND (2015) The validity of the VA surgical risk tool in predicting postoperative mortality among octogenarians. Am J Surg 209:274–279

    Article  PubMed  Google Scholar 

  20. Akyurek N, Salman B, Yuksel O, Tezcaner T, Irkorucu O, Yucel C, Oktar S, Tatlicioglu E (2005) Management of acute calculous cholecystitis in high-risk patients: percutaneous cholecystotomy followed by early laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 15:315–320

    Article  PubMed  Google Scholar 

  21. 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 12:1778–1784

    Article  PubMed  Google Scholar 

  22. Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR (2010) Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 97:141–150

    Article  CAS  PubMed  Google Scholar 

  23. Zafar SN, Obirieze A, Adesibikan B, Cornwell EE, 3rd, Fullum TM, Tran DD (2015) Optimal time for early laparoscopic cholecystectomy for acute cholecystitis. JAMA Surg 150:129–136

    Article  PubMed  Google Scholar 

  24. Dimou FM, Adhikari D, Mehta HB, Riall TS (2017) Outcomes in older patients with grade III cholecystitis and cholecystostomy tube placement: a propensity score analysis. J Am Coll Surg. doi:10.1016/j.jamcollsurg.2016.12.021

    PubMed  Google Scholar 

  25. Ambe PC, Kaptanis S, Papadakis M, Weber SA, Zirngibl H (2015) Cholecystectomy vs. percutaneous cholecystostomy for the management of critically ill patients with acute cholecystitis: a protocol for a systematic review. Syst Rev 4:77

    Article  PubMed  PubMed Central  Google Scholar 

  26. Smith T, Li X, Nylander W, Gunnar W (2016) Thirty-day postoperative mortality risk estimates and 1-year survival in veterans health administration surgery patients. JAMA Surg 151(5):417–422. doi:10.1001/jamasurg.2015.4882

    Article  PubMed  Google Scholar 

  27. McDermott K, Maynard C, Trivedi R, Lowy E, Fihn S (2012) Factors associated with presenting > 12 hours after symptom onset of acute myocardial infarction among Veteran men. BMC Cardiovasc Disord 12:82

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kortram K, van Ramshorst B, Bollen TL, Besselink MG, Gouma DJ, Karsten T, Kruyt PM, Nieuwenhuijzen GA, Kelder JC, Tromp E, Boerma D (2012) Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): study protocol for a randomized controlled trial. Trials 13:7

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. Loretta Coady-Fariborzian for her assistance in obtaining IRB approval.

Funding

Tyler J. Loftus was supported by post-graduate training grant (Grant No. T32 GM-08721) from the National Institute of General Medical Sciences (NIMGS). Alicia M. Mohr was supported by (Grant No. P50 GM111152–010) and (Grant No. R01 GM105893-01) from the NIGMS.

Author contributions

TJL, EMC, and WJZ contributed to the study design. TJL, EMC, CGD, and ANH contributed to data collection and analysis. AMM, RMT, and CEH contributed to data analysis and critical revisions. GAS and WJZ contributed to the study design, data analysis, and critical revisions.

Author information

Authors and Affiliations

  1. Department of Surgery, The University of Florida, Gainesville, FL, USA

    Tyler J. Loftus, Elisha M. Collins, Camille G. Dessaigne, Alicia M. Mohr, Ryan M. Thomas, George A. Sarosi Jr & William J. Zingarelli

  2. The Malcom Randall Veterans Affairs Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608, USA

    Tyler J. Loftus, Elisha M. Collins, Camille G. Dessaigne, Ryan M. Thomas, Charles E. Hobson, George A. Sarosi Jr & William J. Zingarelli

  3. The University of Florida College of Medicine, Gainesville, FL, USA

    Amber N. Himmler

Authors
  1. Tyler J. Loftus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elisha M. Collins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Camille G. Dessaigne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amber N. Himmler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alicia M. Mohr
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryan M. Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Charles E. Hobson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. George A. Sarosi Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. William J. Zingarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William J. Zingarelli.

Ethics declarations

Disclosures

Tyler J. Loftus, Elisha M. Collins, Camille G. Dessaigne, Amber N. Himmler, Alicia M. Mohr, Ryan M. Thomas, Charles E. Hobson, George A. Sarosi Jr. and William J. Zingarelli have no conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Loftus, T.J., Collins, E.M., Dessaigne, C.G. et al. Percutaneous cholecystostomy: prognostic factors and comparison to cholecystectomy. Surg Endosc 31, 4568–4575 (2017). https://doi.org/10.1007/s00464-017-5517-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-017-5517-x

Keywords

Search

Navigation