Barriers to interval cholecystectomy following percutaneous cholecystostomy in patients with acute calculous cholecystitis.

Background: Percutaneous cholecystostomy (PCT) is an option for acute calculous cholecystitis in high-risk surgical patients. While PCT effectively manages acute episodes by providing source control, the management after PCT remains unclear. When feasible, subsequent interval cholecystectomy (IC) offers definitive disease resolution; however, clear guidelines for patient selection remain lacking. This study identifies factors that hinder the decision to proceed with IC, investigates whether IC after PCT is associated with improved survival, and assesses the incidence of subsequent biliary procedures after PCT.

Methods: A retrospective cohort study was conducted using deidentified data from the TriNetX platform, encompassing over 100 million patients. Patients diagnosed with acute calculous cholecystitis who underwent PCT were identified. The primary outcome was the identification of factors associated with the failure to undergo IC after PCT. Secondary outcomes included assessing the hazard of death associated with IC, modeling IC as a time-varying covariate. Additionally, biliary interventions following PCT were quantified.

Results: Among 419,102 patients with acute calculous cholecystitis, 8,483 (2.0%) underwent PCT. Of these, 43.0% subsequently underwent IC within one year. Patients with chronic ischemic heart disease, congestive heart failure, chronic obstructive pulmonary disease, ascites, diabetes, and concurrent diagnosis of septic shock were less likely to undergo IC. Additionally, 40.9% of patients required at least one additional biliary intervention within one year following PCT.

Conclusion: More than half of patients do not undergo IC after PCT. Patients with comorbidities such as chronic ischemic heart disease, congestive heart failure, chronic obstructive pulmonary disease, ascites, diabetes, and concurrent diagnosis of septic shock are associated with failure to undergo IC. Moreover, patients who undergo PCT frequently require additional biliary interventions. This highlights the need for improved patient selection, structured follow-up, and optimization strategies to facilitate IC when feasible. A multidisciplinary approach is crucial for managing comorbidities, increasing surgical eligibility, and ultimately improving outcomes for patients undergoing PCT for acute calculous cholecystitis.