Surgery today · 2026
Pre-admission Barthel Index and serum albumin are associated with discharge to the pre-admission residence after percutaneous transhepatic gallbladder drainage for acute cholecystitis.
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Nakamura Sota, Tada Kazuhiro, Yamashita Yo-Ichi, Inomata Naotaka, Sakata Kazuhito, Yoshiya Shohei, Kuroda Yosuke, Yoshizumi Fumitaka, Iwaki Kentaro, Hiroshige Shoji, Takeuchi Hideya, Fukuzawa Kengo, Yoshizumi Tomoharu
Аннотация
PURPOSE: Percutaneous transhepatic gallbladder drainage (PTGBD) is often performed for acute cholecystitis in medically fragile patients, but the factors associated with discharge to the pre-admission residence remain unclear. Thus, we examined the determinants of discharge to the pre-admission residence after PTGBD.
METHODS: The subjects of this retrospective study were 73 patients who underwent PTGBD for acute cholecystitis between March 2018 and March 2025. The primary outcome was final discharge to the pre-admission residence, defined as discharge without escalation of residential care needs. Multivariable logistic regression included age, sex, pre-admission Barthel Index (BI), serum albumin (ALB), Tokyo Guidelines 2018 severity, and interval cholecystectomy.
RESULTS: The median age was 79 years (interquartile range, 68-85 years), and 55 patients (75.3%) resided in a nursing-care facility or a long-term care hospital before admission. Thirty-seven patients (50.7%) underwent interval cholecystectomy. Patients discharged to their pre-admission residence had a higher BI and ALB. Multivariable analysis identified BI (per 5-point increase; adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.17-1.83; p = 0.002) and ALB (per 0.5 g/dL increase; aOR, 5.03; 95% CI, 1.69-26.01; p = 0.017), but not interval cholecystectomy, as being independently associated with outcome.
CONCLUSIONS: Pre-admission BI and ALB may help identify patients who need early discharge planning and supportive care.
METHODS: The subjects of this retrospective study were 73 patients who underwent PTGBD for acute cholecystitis between March 2018 and March 2025. The primary outcome was final discharge to the pre-admission residence, defined as discharge without escalation of residential care needs. Multivariable logistic regression included age, sex, pre-admission Barthel Index (BI), serum albumin (ALB), Tokyo Guidelines 2018 severity, and interval cholecystectomy.
RESULTS: The median age was 79 years (interquartile range, 68-85 years), and 55 patients (75.3%) resided in a nursing-care facility or a long-term care hospital before admission. Thirty-seven patients (50.7%) underwent interval cholecystectomy. Patients discharged to their pre-admission residence had a higher BI and ALB. Multivariable analysis identified BI (per 5-point increase; adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.17-1.83; p = 0.002) and ALB (per 0.5 g/dL increase; aOR, 5.03; 95% CI, 1.69-26.01; p = 0.017), but not interval cholecystectomy, as being independently associated with outcome.
CONCLUSIONS: Pre-admission BI and ALB may help identify patients who need early discharge planning and supportive care.