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Patterns of care after cholecystostomy tube placement

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Abstract

Background

The use of cholecystostomy (c-tube) in acute cholecystitis (AC) has increased yet there is limited evidence to guide surgical decision-making after placement. As a result, there is variability in the use and timing of cholecystectomy after c-tube. We aimed to describe patient characteristics, outcomes, and biliary-related utilization in those who did and did not have cholecystectomy after c-tube.

Methods

This is a retrospective cohort study (2007–2017) using the MarketScan® claims database of patients (18–63 years) with at least 3 months of follow-up (or death). ICD-9/10 and CPT codes were used to identify AC, c-tube placement, cholecystectomy and determine Elixhauser comorbidity index.

Results

A total of 2386 patients (47.5% female, mean age 52.5 [SD 9.9] years) with AC underwent c-tube with an 11.2% 90-day mortality. Among survivors, by three months 57% underwent cholecystectomy (mean 34.8 days [95% CI: 33.3–36.3]). Cholecystectomy after c-tube was more common in those with fewer comorbid conditions (mean 2.41 [95% CI: 2.26–2.56] vs 4.56 [95%CI: 4.36–4.76]). Biliary episodes prior to cholecystectomy occurred in 12.5% and were associated with eventual cholecystectomy (HR 1.49 [1.32–1.68]). Biliary-specific hospital and ICU days were similar between groups. Biliary-specific ED visits were more common among patients with cholecystectomy (mean 1.39 [95% CI: 1.29–1.48] vs 0.94 [95% CI: 0.85–1.03]).

Conclusion

More than half of patients treated with c-tube underwent cholecystectomy by three months—most within five weeks of AC diagnosis. The high frequency of use and short time to cholecystectomy after c-tube raises questions about potential overuse of c-tube in the initial period. Future work should aim to understand how patient experience and indication for c-tube influence the likelihood and timing of subsequent cholecystectomy.

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Acknowledgements

This work is supported by a training grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number T32DK070555.

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Authors and Affiliations

  1. Department of Surgery, Surgical Outcomes Research Center, University of Washington, 1107 NE 45th Street, Suite 502, UW Box 354808, Seattle, WA, 98105, USA

    Alex Lois, Erin Fennern, Sara Cook, David Flum & Giana Davidson

  2. Department of Health Services, University of Washington, Seattle, WA, USA

    David Flum & Giana Davidson

  3. Department of Pharmacy, University of Washington, Seattle, WA, USA

    David Flum

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  1. Alex Lois
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  2. Erin Fennern
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Correspondence to Alex Lois.

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Drs. Lois, Fennern, Cook, Flum, and Davidson have no conflicts of interest to disclose.

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Lois, A., Fennern, E., Cook, S. et al. Patterns of care after cholecystostomy tube placement. Surg Endosc 36, 2778–2785 (2022). https://doi.org/10.1007/s00464-021-08562-3

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