title: Cholecystostomy offers no survival benefit in patients with acute acalculous cholecystitis and severe sepsis and shock.
abstract: BACKGROUND
  Acute acalculous cholecystitis is often managed with cholecystectomy or cholecystostomy, but data guiding surgical practice are lacking.
  
  
  METHODS
  Longitudinal analysis of the California Office of Statewide Health Planning and Development Patient Discharge Data was performed from 1995-2009. Patients with acute acalculous cholecystitis were identified by International Classification of Diseases 9 code. Cox proportional hazard analysis found predictors of time to death, adjusting for patient demographics, sepsis, shock, frailty, Charlson comorbidity index, length of stay, insurance status, teaching hospital status, and year.
  
  
  RESULTS
  Of 43,341 patients, 63.5% received a cholecystectomy, 2.8% received a cholecystostomy, and 1.2% received both. Overall, 30.4% of patients died, with higher mortality among patients with cholecystostomy (61.7%) or no procedure (42.0%) than cholecystectomy (23.0%). In patients with severe sepsis and shock, there was no difference in survival of patients with cholecystostomy versus no intervention (hazard ratio [HR] 1.13, P = 0.256), although patients with cholecystectomy (with or without prior cholecystostomy) had improved survival (HR 0.29, P < 0.001; HR 0.56, P < 0.001). Results were similar among patients on the ventilator >96 h.
  
  
  CONCLUSIONS
  Although cholecystostomy offered no survival benefit for patients with severe sepsis and shock, cholecystectomy offered improved survival compared with patients without surgical management. Cholecystostomy may not benefit the sickest patients in whom cholecystectomy may never be considered.
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, California. Electronic address: jaa002@ucsd.edu.
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Anderson
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, California.
authors.forename: Tazo
authors.initials: T
authors.lastname: Inui
authors.affiliation: Department of Surgery, SUNY Stony Brook, Stony Brook, New York.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Talamini
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, California.
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
mesh_terms: D042101:Acalculous Cholecystitis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D002763:Cholecystectomy / Q000401:mortality*; D002767:Cholecystostomy / Q000401:mortality*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012772:Shock, Septic / Q000150:complications* / Q000401:mortality
keywords: Cholecystectomy; Cholecystitis; Cholecystostomy; Surgical outcomes