title: Acute cholecystitis in high surgical risk patients: percutaneous cholecystostomy or emergency cholecystectomy?
abstract: BACKGROUND
  Percutaneous cholecystostomy (PC) is an alternative treatment in acute cholecystitis (AC) in high-risk or elderly patients although its advantage over emergency cholecystectomy has not yet been established.
  
  
  METHODS
  AC prospective database analysis in high-risk patients treated by PC (group 1, 29 patients) or emergency cholecystectomy (group 2, 32 patients). Surgical risk was estimated by physiological POSSUM, Charlson, Apache II, and American Society of Anesthesiologists (ASA) scores.
  
  
  RESULTS
  The groups showed homogeneity concerning age and surgical risk. PC allowed AC resolution in 19 patients (70.4%), but 8 (29.6%) needed emergency cholecystectomy. Morbidity and mortality rates were 31% and 17.2%, respectively. Mortality was significantly associated with ASA IV (P = .01). In group 2, the morbidity rate was 28.1% without mortality. There was no statistical difference in morbidity (P = .6) although mortality was significantly higher in group 1 (P = .02).
  
  
  CONCLUSIONS
  PC seems of little benefit and ought to be left for those very old patients with surgical contraindication.
authors: Department of General Surgery, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.
authors: Juan C
authors: JC
authors: Rodríguez-Sanjuán
authors: Arantxa
authors: A
authors: Arruabarrena
authors: Laura
authors: L
authors: Sánchez-Moreno
authors: Francisco
authors: F
authors: González-Sánchez
authors: Luis A
authors: LA
authors: Herrera
authors: Manuel
authors: M
authors: Gómez-Fleitas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000009:adverse effects / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D041881:Cholecystitis, Acute / Q000601:surgery*; D002767:Cholecystostomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D015986:Confounding Factors, Epidemiologic; D016208:Databases, Factual; D004630:Emergencies; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome