title: Percutaneous cholecystostomy is safe and effective option for acute calculous cholecystitis in select group of high-risk patients.
abstract: OBJECTIVE
  In high-risk patients with acute calculous cholecystitis (ACC), percutaneous cholecystostomy (PC) can serve as a bridging option to cholecystectomy [laparoscopic cholecystectomy (LC)] or as definitive treatment. The purpose of this study was to identify predictors of the need for permanent PC.
  
  
  METHODS
  Data from 257 PCs performed for ACC (mean age 67.3 ± 14) was collected for a 10-year period. Demographic and clinical characteristics at initial admission, co-morbidities were analyzed. Patients who underwent interval LC were defined as the surgery group (SG; n = 163, 63.4 %) and the remaining patients as the non-SG (NSG; n = 94, 36.6 %).
  
  
  RESULTS
  Patients in the SG were significantly younger and had a shorter length of hospital stay (p < 0.01). The rate of coronary artery disease (CAD; 63.2 vs. 20.2 %), chronic renal failure (14.9 vs. 6.1 %), and the mean number of co-morbidities (2.2 vs. 1.4) were significantly higher in the NSG. Sepsis at admission was more common in the NSG (19.1 vs. 4.9 %, p < 0.001). 56 patients (34.4 %) in the SG and 24 patients (25.5 %) in the NSG developed tube-related complications. In hospital mortality was similar between the groups. Multivariate analysis showed that age ≥75, increased alkaline phosphatase (ALK-P), history of CAD, were predictors of PC as a definite treatment in this high-risk group of patients with ACC.
  
  
  CONCLUSIONS
  High operative risk due to older age and CAD preclude LC in more than one-third of patients following PC especially presenting with sepsis and elevated ALK-P. This study suggests that PC could be a safe treatment option in this select group of high-risk patients.
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel. rbalam@hadassah.org.il.
authors.forename: M
authors.initials: M
authors.lastname: Bala
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Mizrahi
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Mazeh
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Yuval
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Eid
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Almogy
mesh_terms: D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000401:mortality / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Acute calculous cholecystitis; Cholecystectomy; Percutaneous tube cholecystostomy; Surgical outcomes