title: Changing trends and outcomes in the use of percutaneous cholecystostomy tubes for acute cholecystitis.
abstract: BACKGROUND
  Percutaneous cholecystostomy tube (PCT) placement serves as a treatment option for acute cholecystitis in elderly and critically ill patients. The objective of this study was to compare PCT and cholecystectomy outcomes over time.
  
  
  METHODS
  PCTs placed from April 1, 1998, to December 31, 2009 (time period 2) were retrospectively reviewed. Patients who underwent cholecystectomies served as matched controls. Institutional data from March 1, 1989, to March 31, 1998 (time period 1) were reviewed to compare trends.
  
  
  RESULTS
  A total of 143 patients successfully underwent PCT placement in time period 2. When compared with patients undergoing cholecystectomy, PCT patients had a higher rate of cardiovascular disease (66% vs 26%, P = 0.001), diabetes (27% vs 13%, P = 0.001), and a higher mean Charlson comorbidity index (3.27 vs 1.07, P = 0.001). Compared with the first time period, patients undergoing PCT in the second time period had lower American Society of Anesthesiologist's classifications (American Society of Anesthesiologist's class I, II: 0% vs 18%, P = 0.001). Thirty-day mortality decreased from 36% to 12% in patients undergoing PCT (P = 0.001).
  
  
  CONCLUSIONS
  Among patients with acute cholecystitis, percutaneous cholecystostomy tubes were placed in older patients with increased comorbidities compared to cholecystectomy. Mortality rates after PCT decreased over time.
authors.affiliation: Department of Medical Education, Gundersen Health System, La Crosse, WI, USA.
authors.forename: Travis J
authors.initials: TJ
authors.lastname: Smith
authors.forename: Jacob G
authors.initials: JG
authors.lastname: Manske
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Mathiason
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Kallies
authors.forename: Shanu N
authors.initials: SN
authors.lastname: Kothari
mesh_terms: D000208:Acute Disease; D000368:Aged; D016009:Chi-Square Distribution; D041881:Cholecystitis, Acute / Q000401:mortality / Q000601:surgery*; D002767:Cholecystostomy / Q000295:instrumentation*; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome