title: Outcomes of percutaneous cholecystostomy and predictors of eventual cholecystectomy.
abstract: BACKGROUND
  Percutaneous cholecystostomy (PC) is an established treatment for high surgical risk patients with acute cholecystitis. This paper studies factors predictive of mortality and eventual cholecystectomy.
  
  
  METHODS
  A retrospective review of all patients who underwent PC from March 2005 to March 2015 was performed. Patient demographics, clinical features, comorbidity profile, grade of cholecystitis, interval between cholecystitis diagnosis and PC, and method of PC were studied. Length of stay, complications, readmission rate, mortality and eventual cholecystectomy were studied. For patients with eventual cholecystectomy, operative data and perioperative outcomes were studied.
  
  
  RESULTS
  One hundred and three patients with median age of 80 years (range 43-105) underwent PC. Median interval to PC was 2 days (range 0-15). 9.7% of patients had complications. Median length of stay was 19 days (range 3-206). 41% underwent eventual cholecystectomy. 30-day mortality rate was 10.7%. Higher APACHE II scores (P = 0.004), higher Charlson comorbidity index (CCI) (P = 0.009), and longer interval from diagnosis to PC (P = 0.037) were associated with in-hospital mortality. Younger age (P = 0.015), lower APACHE II scores (P = 0.043) and lower CCI (P = 0.002) were associated with eventual cholecystectomy.
  
  
  CONCLUSIONS
  Percutaneous cholecystostomy is safe and effective in treatment of acute cholecystitis. Prompt PC improves survival in high risk surgical patients. Comorbidity severity is associated with mortality. Patients with lesser comorbidity are likely to receive eventual cholecystectomy.
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: Charleen Shan Wen
authors.initials: CS
authors.lastname: Yeo
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Vivyan Wei Yen
authors.initials: VW
authors.lastname: Tay
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: Jee Keem
authors.initials: JK
authors.lastname: Low
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
authors.forename: Winston Wei Liang
authors.initials: WW
authors.lastname: Woon
authors.affiliation: Department of Interventional Radiology, Tan Tock Seng Hospital, Singapore.
authors.forename: Sundeep J
authors.initials: SJ
authors.lastname: Punamiya
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. vgshelat@gmail.com.
authors.forename: Vishal G
authors.initials: VG
authors.lastname: Shelat
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000401:mortality; D005544:Forecasting; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cholecystitis; Cholecystostomy; Percutaneous drainage