title: Use of cholecystostomy tubes in the management of patients with primary diagnosis of acute cholecystitis.
abstract: BACKGROUND
  Management of patients with severe acute cholecystitis (AC) remains controversial. In settings where laparoscopic cholecystectomy (LC) can be technically challenging or medical risks are exceedingly high, surgeons can choose between different options, including LC conversion to open cholecystectomy or surgical cholecystostomy tube (CCT) placement, or initial percutaneous CCT. We reviewed our experience treating complicated AC with CCT at a tertiary-care academic medical center.
  
  
  METHODS
  All adult patients (n = 185) admitted with a primary diagnosis of AC and who received CCT from 2002 to 2010 were identified retrospectively through billing and diagnosis codes.
  
  
  RESULTS
  Mean patient age was 71 years and 80% had ≥1 comorbidity (mean 2.6). Seventy-eight percent of CCTs were percutaneous CCT placement and 22% were surgical CCT placement. Median length of stay from CCT insertion to discharge was 4 days. The majority (57%) of patients eventually underwent cholecystectomy performed by 20 different surgeons in a median of 63 days post-CCT (range 3 to 1,055 days); of these, 86% underwent LC and 13% underwent open conversion or open cholecystectomy. In the radiology and surgical group, 50% and 80% underwent subsequent cholecystectomy, respectively, at a median of 63 and 60 days post-CCT. Whether surgical or percutaneous CCT placement, approximately the same proportion of patients (85% to 86%) underwent LC as definitive treatment.
  
  
  CONCLUSIONS
  This 9-year experience shows that use of CCT in complicated AC can be a desirable alternative to open cholecystectomy that allows most patients to subsequently undergo LC. Additional studies are underway to determine the differences in cost, training paradigms, and quality of life in this increasingly high-risk surgical population.
authors.affiliation: Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Cherng
authors.forename: Elan T
authors.initials: ET
authors.lastname: Witkowski
authors.forename: Erica B
authors.initials: EB
authors.lastname: Sneider
authors.forename: Jason T
authors.initials: JT
authors.lastname: Wiseman
authors.forename: Joanne
authors.initials: J
authors.lastname: Lewis
authors.forename: Demetrius E M
authors.initials: DE
authors.lastname: Litwin
authors.forename: Heena P
authors.initials: HP
authors.lastname: Santry
authors.forename: Mitchell
authors.initials: M
authors.lastname: Cahan
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000368:Aged; D041881:Cholecystitis, Acute / Q000097:blood / Q000175:diagnosis*; D002765:Cholecystography; D002767:Cholecystostomy / Q000295:instrumentation*; D016638:Critical Illness; D019299:Decompression, Surgical / Q000295:instrumentation* / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome