Optimal timing for cholecystectomy following percutaneous cholecystostomy: insights from a multicenter retrospective cohort study.

Abstract

Laparoscopic cholecystectomy is the standard of care for patients with acute cholecystitis. However, in high-risk surgical candidates who do not respond to conservative management, percutaneous cholecystostomy is recommended. When used as bridge therapy, the optimal timing for performing laparoscopic cholecystectomy as definitive treatment still remains uncertain. The primary outcome of this study was to assess the incidence of major perioperative complications, defined as Clavien-Dindo grade ≥ III. A retrospective, multicenter, observational cohort study was conducted across nine hospitals-seven in Italy and two in Colombia. We reviewed the medical records of all patients who underwent cholecystectomy following percutaneous cholecystostomy at the participating institutions between January 2020 and December 2024. Patients were stratified into two groups based on the 50th percentile (median) of the time interval between procedures, which was 59 days. Accordingly, the groups were defined as ≤ 59 days (approximately ≤ 8 weeks) and > 59 days (approximately > 8 weeks). A total of 123 patients were included in the study. The median age was 75.0 years, and the majority were male (56.1%). Logistic regression analysis showed that older age and an open surgical approach were significantly associated with a higher risk of major complications. The time interval between cholecystostomy and cholecystectomy was not significantly associated with the risk of major complications in any model. However, in the sensitivity analysis-after excluding outliers above the 95th percentile and below the 5th percentile-the incidence of major complications was 21.1% in the ≤ 8 weeks group versus 11.3% in the > 8 weeks group, without statistically significant differences (p = 0.262). The results of this study suggest that, within the observed range of intervals, no definitive advantage can be attributed to either earlier or delayed surgery based solely on timing. There remains a critical need for a rigorously designed, multicenter prospective study to determine the optimal timing of surgery based on clinically meaningful endpoints.