Ten-Year Experience with Percutaneous Cholecystostomy for Acute Cholecystitis in Men
Journal Title: American Journal of Interventional Radiology - Year 2017, Vol 1, Issue 6
Abstract
Objective: To retrospectively analyze the treatment outcomes of male patients who underwent emergent percutaneous cholecystostomy (PC) for biliary decompression in acute cholecystitis. Methods: A single institution retrospective analysis of 132 patients from 2003 to 2013. Outcome measures were survival, cholecystostomy drain outcomes, and definitive treatment with surgical cholecystectomy. Results: The patient population was all male, with a mean age of 70.6 years. 79 patients (59.9%) were admitted for biliary disease and 34 patients (25.8%) were in an intensive care unit when diagnosed. 18 patients (13.6%) died within 30 days of PC, an additional 12 (9%) died within 6 months of PC, and the median survival was 4.9 years. Multivariate logistic regression showed a direct relationship between 1 month and 6 month mortality with total bilirubin and an inverse relationship with hematocrit. Cox regression analysis for long term survival revealed increased mortality associated with respiratory failure (hazard ratio (HR):2.40, P=0.023) and total bilirubin (HR:1.11, P<0.001); lower mortality was associated with a primary diagnosis of cholecystitis (HR:0.29, P=0.010), higher hematocrit (HR:0.89, P<0.001), and ICU (HR:0.17, P=0.003) and floor (HR:0.34, P=0.029) diagnosis location. Only 55 patients (41.7%) proceeded to surgical cholecystectomy. Outcomes at 1 year (n=110) were 40% alive after surgery, 25.5% alive without surgery or a drain, 2.7% alive without surgery but with a drain, and 31.8% dead. Conclusions: Although PC is associated with a high early mortality, 25.5 % of our patients were definitively treated with cholecystostomy alone. Certain biomarkers and patient characteristics may help model survival after PC.
Authors and Affiliations
Melissa F Perkal, Joseph T King, Bishwajit Bhattacharya, Robert B Schlessel, Gowthaman Gunabushanam
Keywords
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- EP ID EP365731
- DOI 10.25259/AJIR-7-2017
- Views 107
- Downloads 0
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