Impact of percutaneous cholecystostomy timing on clinical outcomes in moderate-to-severe acute cholecystitis.

objectivesThe optimal timing of percutaneous cholecystostomy (PC) in moderate-to-severe acute cholecystitis remains uncertain. This study evaluated the relationship between PC timing and clinical outcomes, particularly hospital length of stay (LOS), in patients with Tokyo Grade II-III acute cholecystitis.

methodsThis retrospective single-center study included 102 patients with Tokyo Grade II-III acute cholecystitis who underwent PC between January 2022 and January 2025. Patients were classified as early (≤24 h), intermediate (25-48 h), or delayed (≥49 h) according to the timing of drainage. Clinical outcomes included LOS, recurrence, in-hospital mortality, hepatopancreatobiliary complications, catheter-related complications, and interval cholecystectomy. Multivariable linear regression analyses using separate ASA-based and Charlson Comorbidity Index (CCI)-based models were performed to identify independent predictors of LOS.

resultsThe mean age was 72.8 years. Sixty-six patients (64.7%) had Tokyo Grade III disease. Mean LOS was 8.76 ± 6.71 days in the early group, 9.45 ± 4.91 days in the intermediate group, and 13.33 ± 9.66 days in delayed group (p = 0.030), with similar findings in both Tokyo Grade II and III subgroups. In multivariable regression analyses, procedural timing remained an independent predictor of LOS in both ASA-based and CCI-based models. Hemoglobin showed a borderline negative association, whereas albumin, Tokyo grade, ASA score, and CCI were not independently associated with LOS. Earlier intervention was also associated with greater white blood cell reduction (p = 0.024).

conclusionEarlier PC was associated with shorter hospitalization and greater early inflammatory improvement. Procedural timing was the most consistent independent predictor of LOS.