Variability in percutaneous cholecystostomy use for acute cholecystitis: A statewide analysis of patient and hospital characteristics.

BACKGROUND

Medically high-risk patients with acute cholecystitis may undergo percutaneous cholecystostomy tube (PCT) as an alternative to cholecystectomy. We explored the impact of patient and hospital characteristics on PCT use.

METHODS

We retrospectively reviewed the Maryland HSCRC database (4/1/2022-3/31/2024), including ED patients admitted with acute cholecystitis who underwent inpatient cholecystectomy or PCT. Univariate analyses and mixed-effects logistic regression models were performed to evaluate predictors of PCT placement.

RESULTS

Among 8112 patients across 40 Maryland hospitals, 990 (12%) received PCT. Age and clinical severity had the strongest association with PCT use, though sex and insurance status were also significant factors. After accounting for patient characteristics, hospital factors-including hospital size, procedure volume, surgery residency, trauma designation, and Leapfrog grade-were not independently associated with PCT use.

CONCLUSION

Patient and hospital characteristics together explain less than 60% of between-hospital variability in PCT use, warranting further investigation into clinical considerations that optimize PCT management.