title: Management of acute cholecystitis: prevalence of percutaneous cholecystostomy and delayed cholecystectomy in the elderly.
abstract: BACKGROUND
  Published guidelines recommend early cholecystectomy for acute cholecystitis in the elderly. Alternatively, percutaneous cholecystostomy can be used in compromised patients.
  
  
  METHODS
  We reviewed 806 elderly patients diagnosed with biliary disease retrospectively identified through billing and diagnosis codes. Two hundred sixty-five patients with histologically documented acute cholecystitis were selected.
  
  
  RESULTS
  Initially, 75 patients had percutaneous cholecystostomy (Group 1), 64 (24 % underwent interval cholecystectomy, 74 (28 %) early (Group 2), and 127 (48 %) delayed cholecystectomy (Group 3). Group 1 was more likely to have American Society of Anesthesiologists (ASA) scores of 4 when compared to those in Groups 2 and 3 (p = 0.04). No difference existed among the groups when patients with an ASA of 4 were excluded: conversion rates (11 %), biliary leak, bowel injury, need for reoperation, or 30 days mortality. Patients in Group 1 and in Group 3 were five times (p = 0.04) and four times (p = 0.06) more likely, respectively, than those in Group 2 to have recurrent episodes of pancreatitis, cholecystitis, and cholangitis.
  
  
  CONCLUSIONS
  Patients were more likely to have delayed cholecystectomy after initial antibiotic therapy or cholecystostomy without the benefit of a lower conversion rate when compared to the early group, but they had higher recurrent episodes of cholecystitis/pancreatitis or cholangitis.
authors.affiliation: Department of General Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Cull
authors.forename: Jose M
authors.initials: JM
authors.lastname: Velasco
authors.forename: Alexander
authors.initials: A
authors.lastname: Czubak
authors.forename: Dahlia
authors.initials: D
authors.lastname: Rice
authors.forename: Eric C
authors.initials: EC
authors.lastname: Brown
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D002761:Cholangitis / Q000209:etiology; D041881:Cholecystitis, Acute / Q000150:complications / Q000601:surgery*; D002767:Cholecystostomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D061887:Conversion to Open Surgery; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007422:Intestines / Q000293:injuries; D010535:Laparoscopy; D008297:Male; D010195:Pancreatitis / Q000209:etiology; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors