RF 4 - CHOLECYSTECTOMY AFTER PERCUTANEOUS CHOLECYSTOSTOMY FOR ACUTE CHOLECYSTITIS: INITIAL EXPERIENCE AND OUTCOMES IN AN ACADEMIC PRACTICE

Objectives: Percutaneous cholecystostomy (PC) represents an important treatment approach in patients with acute cholecystitis (AC) who are unfit for laparoscopic cholecystectomy (LC). However, the optimal timing to perform LC for definitive treatment after PC is unknown. This study aimed to investigate the effect of the interval between PC and LC on perioperative complications.

Methods: This retrospective cohort study included adult patients diagnosed with AC who underwent PC followed by LC at a single academic center between 2016 and 2020. Patients with a history of hepatobiliary surgery, common bile duct stones, cirrhosis, active malignancy, or chronic immunosuppressive therapy were excluded. Additionally, baseline demographics, PC and LC hospitalization data, and perioperative outcomes following LC were collected. Linear and logistic regression models were used to analyze the impact of the interval between PC and LC on perioperative outcomes.

Results: One hundred twelve patients (60% male) with a mean age of 64.6 ± 1.4 (mean ± SD) years were diagnosed with AC (55% mild, 37% moderate, 9% severe), and underwent PC on average 1.8 days following diagnosis. The median interval between PC and LC was 65 days (interquartile range [IQR] 48-97) and was not associated with procedure duration, estimated blood loss, or length of hospitalization (Table1). The timing of LC also did not influence the 30 day readmission (OR 0.988, p=0.602), reintervention (OR 0.994, p=0.469), emergency department visits (OR 0.994, p= 0.370), biliary injury (OR 0.987, p=0.679), leak (OR 0.99, p=0.831), intraoperative events (OR 0.979, p=0.164) or the rate of conversion to open (OR 0.989, p=0.267). However, delayed LC after PC increased the intensive care unit (ICU) stay significantly (Coef 0.003, p< 0.001).

Conclusion: While the timing of LC after PC did not influence the perioperative outcomes longer intervals were associated with significantly increased length of ICU stay. Based on these findings, patients may benefit from early LC after percutaneous cholecystostomy for AC. Multi-isntitutional studies are necessary to confirm these results.