Factors affecting interval cholecystectomy and mortality in percutaneous cholecystostomy patients.

backgroundPercutaneous cholecystostomy is an alternative or bridge to cholecystectomy (CCY) in high-risk patients with acute calculous cholecystitis. Our primary aim was to determine the parameters that could be used in interval CCY decision-making and to predict mortality in high-risk patients.

methodsThe medical records of 127 patients who underwent percutaneous cholecystostomy for acute calculous cholecystitis between 2010 and 2018 were retrospectively analyzed. The primary outcomes were the CCY rate and the factors affecting mortality in high-risk patients. Descriptive statistics and receiver operating characteristic analysis were performed using albumin and elective surgery.

resultsOf the 127 patients undergoing percutaneous cholecystostomy, elective CCY was performed only in 43.1% of the high-risk patients. The 30-day and 1 year mortality rates were 11% and 17.3%, respectively. The American Society of Anesthesiologists' (ASA) score, Charlson comorbidity index (CCI), the negative predictive factors described in the Tokyo Guidelines 2018, the American College of Surgeons' (ACS) expected mortality rate, and albumin level were found to be significant factors affecting mortality and elective CCY probability. No mortality was observed, and an 82% elective CCY rate was achieved in patients whose albumin levels were higher than 3.16 mg/dL at initial presentation.

conclusionThe plasma albumin level, ASA score, CCI, and ACS expected mortality rate can be used to predict mortality and decide on elective CCY. Percutaneous cholecystostomy is sufficient for resolving inflammation, but medical comorbidities determine the final condition of patients.