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Management of Acute Cholecystitis: Prevalence of Percutaneous Cholecystostomy and Delayed Cholecystectomy in the Elderly

  • 2013 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Published guidelines recommend early cholecystectomy for acute cholecystitis in the elderly. Alternatively, percutaneous cholecystostomy can be used in compromised patients.

Methods

We reviewed 806 elderly patients diagnosed with biliary disease retrospectively identified through billing and diagnosis codes. Two hundred sixty-five patients with histologically documented acute cholecystitis were selected.

Results

Initially, 75 patients had percutaneous cholecystostomy (Group 1), 64 (24 % underwent interval cholecystectomy, 74 (28 %) early (Group 2), and 127 (48 %) delayed cholecystectomy (Group 3). Group 1 was more likely to have American Society of Anesthesiologists (ASA) scores of 4 when compared to those in Groups 2 and 3 (p = 0.04). No difference existed among the groups when patients with an ASA of 4 were excluded: conversion rates (11 %), biliary leak, bowel injury, need for reoperation, or 30 days mortality. Patients in Group 1 and in Group 3 were five times (p = 0.04) and four times (p = 0.06) more likely, respectively, than those in Group 2 to have recurrent episodes of pancreatitis, cholecystitis, and cholangitis.

Conclusion

Patients were more likely to have delayed cholecystectomy after initial antibiotic therapy or cholecystostomy without the benefit of a lower conversion rate when compared to the early group, but they had higher recurrent episodes of cholecystitis/pancreatitis or cholangitis.

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Authors and Affiliations

  1. Department of General Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA

    John D. Cull

  2. Department of Surgery, NorthShore University HealthSystem and Professor of Surgery, Rush University, 9600 Gross Point Road, Skokie, IL, 60076, USA

    Jose M. Velasco

  3. NorthShore University HealthSystem, 9600 Gross Point Road, Skokie, IL, 60076, USA

    Alexander Czubak

  4. Rush Medical College, 1653 W. Congress Parkway, Chicago, IL, 60612, USA

    Dahlia Rice

  5. Research Informatic Administration, NorthShore University HealthSystem, 1001 University Place, Evanston, IL, 60201, USA

    Eric C. Brown

Authors
  1. John D. Cull
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  2. Jose M. Velasco
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  3. Alexander Czubak
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  4. Dahlia Rice
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Correspondence to Jose M. Velasco.

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Cull, J.D., Velasco, J.M., Czubak, A. et al. Management of Acute Cholecystitis: Prevalence of Percutaneous Cholecystostomy and Delayed Cholecystectomy in the Elderly. J Gastrointest Surg 18, 328–333 (2014). https://doi.org/10.1007/s11605-013-2341-z

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  • DOI: https://doi.org/10.1007/s11605-013-2341-z

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