title: Perioperative outcomes of delayed laparoscopic cholecystectomy for acute calculous cholecystitis with and without percutaneous cholecystostomy.
abstract: BACKGROUND
  The role of percutaneous cholecystostomy (PC) in the management of patients with acute calculous cholecystitis (ACC) remains controversial. The aim of this study is to report operative outcomes in a large cohort of patients undergoing PC before their delayed laparoscopic cholecystectomy (DLC).
  
  
  METHODS
  All patients who underwent DLC because of ACC between 2003 and 2012 were included. Outcomes of patients with and without previous PC were compared.
  
  
  RESULTS
  Of 639 patients who underwent DLC because of ACC at our institution during a 10-year time interval beginning 2003, 163 (25.5%) patients had PC before their DLC. Patients who underwent PC were older (64 ± 1 years vs 48 ± 0.8 years, P < .001) and had more comorbid conditions (P < .001). Accumulated duration of stay was longer in the PC group (16.2 ± 0.4 days vs 9.7 ± 0.1 days, P < .001). Rate of conversion to open procedure was greater in the PC group (11% vs 4%, P = .001) and operative time was longer (142 ± 4 minutes vs 107 ± 4 minutes, P < .001). Patients in the PC group had a greater rate of biliary-related complications (10% vs 4%, P = .003) and surgical-site infections; both superficial (5% vs 1%, P = .004) and deep (7% vs 3%, P = .04). On multivariable analysis PC was an independent risk factor for conversion to open cholecystectomy (odds ratio 2.67 95% CI 1.18-6.72) as well as to biliary-related complications (odds ratio 4.85 95% CI 1.57-14.92).
  
  
  CONCLUSIONS
  DLC for ACC in patients with previous PC is associated with longer duration of stay, more readmissions, and, most importantly, greater conversion rate, biliary related complications, and surgical-site infections.
authors.affiliation: Department of Surgery and Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ido
authors.initials: I
authors.lastname: Mizrahi
authors.affiliation: Department of Surgery and Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: hmazeh@hadassah.org.il.
authors.forename: Haggi
authors.initials: H
authors.lastname: Mazeh
authors.affiliation: Department of Surgery and Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Yuval
authors.affiliation: Department of Surgery and Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Gidon
authors.initials: G
authors.lastname: Almogy
authors.affiliation: Department of Surgery and Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Miklosh
authors.initials: M
authors.lastname: Bala
authors.affiliation: Department of Surgery and Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Natalia
authors.initials: N
authors.lastname: Simanovski
authors.affiliation: Department of Surgery and Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Nadeen Abu
authors.initials: NA
authors.lastname: Ata
authors.affiliation: Department of Surgery and Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Kuchuk
authors.affiliation: Department of Surgery and Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Rachmuth
authors.affiliation: Department of Surgery and Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Aviram
authors.initials: A
authors.lastname: Nissan
authors.affiliation: Department of Surgery and Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Eid
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome