The Treatment of Critically Ill Patients With Acute Cholecystitis.
BACKGROUND
Besides cholecystectomy (CC), percutaneous cholecystostomy (PC) has been recommended for the management of critically ill patients with acute cholecystitis. However, solid evidence on the benefit of PC in this subgroup of patients is lacking.


METHODS
In accordance with the PRISMA guidelines for systematic reviews, we systematically searched the Cochrane Library, CINAHL, MEDLINE, Embase, and Scopus for relevant studies published between 2000 and 2014. Two investigators independently screened the studies included.


RESULTS
Six studies with a total of 337 500 patients (PC 10 045, CC 327 455) were included for meta-analysis. Significant differences in favor of CC were recorded with regard to the rate of mortality (OR 4.28, [1.72 to 10.62], p = 0.0017), length of hospital stay (OR 1.41, [1.02 to 1.95], p = 0.04), and the rate of readmission for biliary complaints (OR 2.16, [1.72 to 2.73], p<0.0001). There was no statistically significant difference between both intervention arms with regard to complications (OR 0.74, [0.36 to 1.53], p = 0.42) and re-interventions (OR 7.69, [0.68 to 87.33], p = 0.10).


CONCLUSIONS
The benefit of percutaneous cholecystostomy (PC) over cholecystectomy (CC) in the management of critically ill patients with acute cholecystitis could not be proven in this systematic review.
Department of General and Visceral Surgery, HELIOS University Hospital Wuppertal, Universität Witten-Herdecke, Homerton University Hospital, Queen Mary, University of London, Großbritannien, Department of Internal Medicine, St. Elisabeth Krankenhaus Köln-Hohenlind.
Peter C
PC
Ambe
Sarantos
S
Kaptanis
Marios
M
Papadakis
Sebastian A
SA
Weber
Stefan
S
Jansen
Hubert
H
Zirngibl
D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000401:mortality* / Q000706:statistics & numerical data*; D041881:Cholecystitis, Acute / Q000401:mortality* / Q000601:surgery*; D002767:Cholecystostomy / Q000401:mortality* / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D019317:Evidence-Based Medicine; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome