Surgical laparoscopy, endoscopy & percutaneous techniques · 2026
The Impact of Percutaneous Cholecystostomy Timing on Mortality and Morbidity in High-Risk Patients With Acute Calculous Cholecystitis.
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Işik Ali Levent, Bekraki Ali
Аннотация
BACKGROUND: The optimal timing of percutaneous cholecystostomy (PC) in acute cholecystitis remains unclear, despite its increasing adoption as a treatment option for elderly and critically ill patients. This study aimed to evaluate the impact of PC timing on complications, hospital stay, and mortality in high-risk patients with moderate and severe acute calculous cholecystitis.
MATERIALS AND METHODS: Between 2020 and 2024, 124 consecutive patients who underwent PC were retrospectively reviewed. The time periods from admission to PC were measured. Patients with grade II cholecystitis who had a Charlson Comorbidity Index (CCI) score ≥6 and an American Society of Anesthesiologists Physical Status (ASA-PS) score ≥3, and those with grade III cholecystitis who had a CCI score ≥4 and an ASA-PS score ≥3, were defined as high-risk patients using TG18-aligned thresholds. Among these 82 high-risk patients, the median time from admission to PC was 39 hours (range: 21 to 62 h).
RESULTS: Early high-risk group (≤48 h; n=51) had shorter hospital stay [7 (5 to 8) vs. 13 (6 to 20) d; P <0.001], lower ≤90-day mortality rate (5.9% vs. 22.6%; P =0.037) and lower ≤365-day mortality rate (7.8% vs. 25.8%; P =0.049) as compared with delayed high-risk group (>48 h; n=31). Delayed PC (OR=4.80, P =0.004) and complications related to PC (OR=4.37, P =0.015) were independent risk factors for longer hospital stay. A higher CCI Score (≥7) (OR=13.68, P =0.047) and delayed PC (OR=8.64, P =0.04) were independent risk factors for in-hospital mortality.
CONCLUSIONS: While emergency cholecystectomy remains the gold standard for the treatment of acute cholecystitis, PC represents a valuable initial treatment alternative in high-risk patients when performed at an early stage. Early PC provides significant advantages, including fewer complications, shorter hospitalization, and reduced in-hospital mortality.
MATERIALS AND METHODS: Between 2020 and 2024, 124 consecutive patients who underwent PC were retrospectively reviewed. The time periods from admission to PC were measured. Patients with grade II cholecystitis who had a Charlson Comorbidity Index (CCI) score ≥6 and an American Society of Anesthesiologists Physical Status (ASA-PS) score ≥3, and those with grade III cholecystitis who had a CCI score ≥4 and an ASA-PS score ≥3, were defined as high-risk patients using TG18-aligned thresholds. Among these 82 high-risk patients, the median time from admission to PC was 39 hours (range: 21 to 62 h).
RESULTS: Early high-risk group (≤48 h; n=51) had shorter hospital stay [7 (5 to 8) vs. 13 (6 to 20) d; P <0.001], lower ≤90-day mortality rate (5.9% vs. 22.6%; P =0.037) and lower ≤365-day mortality rate (7.8% vs. 25.8%; P =0.049) as compared with delayed high-risk group (>48 h; n=31). Delayed PC (OR=4.80, P =0.004) and complications related to PC (OR=4.37, P =0.015) were independent risk factors for longer hospital stay. A higher CCI Score (≥7) (OR=13.68, P =0.047) and delayed PC (OR=8.64, P =0.04) were independent risk factors for in-hospital mortality.
CONCLUSIONS: While emergency cholecystectomy remains the gold standard for the treatment of acute cholecystitis, PC represents a valuable initial treatment alternative in high-risk patients when performed at an early stage. Early PC provides significant advantages, including fewer complications, shorter hospitalization, and reduced in-hospital mortality.