Optimal Timing of Percutaneous Cholecystostomy across Different Grades of Acute Cholecystitis: A Retrospective Cohort Study

Abstract

Purpose

To investigate the effect of percutaneous cholecystostomy (PC) tube placement timing on clinical outcomes in patients with Grade I–III acute cholecystitis (AC) who did not undergo surgery.

Materials and Methods

This retrospective single-center cohort study included patients with AC who initially underwent PC between October 2018 and December 2022. The following outcomes were analyzed: (a) rate of all-cause in-hospital mortality (IHM), (b) length of hospital stay (LOS), (c) duration of intensive care unit stay, and (d) rate of recurrence, which were correlated with clinical and procedural characteristics, disease severity, and PC timing. Subgroup analysis was then performed to investigate the effects of drainage timing across different severity grades.

Results

This study included 183 patients. Severity grade, drainage timing, age, and Charlson Comorbidity Index score significantly influenced LOS (P < .001, P = .002, P = .001, and P = .010, respectively). In the subgroup analysis, PC performed within 24 hours in patients with Grade II AC significantly shortened LOS (median, 7.0 vs 10.0 days; P = .028). In patients with Grade III AC, PC performed after 6 hours significantly extended LOS (median, 19.0 vs 9.0 days; P = .010). Multivariate analysis indicated that IHM was associated with severity grade and age (P = .009 and P = .008, respectively) but not drainage timing.

Conclusions

Urgent drainage may be unnecessary for patients with Grade I or II AC. However, a reduction in LOS was observed for patients with Grade III AC who underwent PC within 6 hours and those with Grade II AC who underwent PC within 24 hours after admission.