BACKGROUND: Current data on the clinical course of patients with acute cholecystitis managed with percutaneous cholecystostomy (PC) are limited by small sample size and imperfect follow-up. We present the characteristics and clinical course of a population-based cohort with acute cholecystitis managed with PC. METHODS: We designed a retrospective cohort study using administrative databases capturing all emergency department (ED) visits and hospital admissions within a geographic region with a population of more than 13 million. From all adults with a first emergency admission for acute cholecystitis from 2004 to 2011, those managed with PC were included in the cohort. The cumulative incidences of subsequent cholecystectomy and death were calculated, considering death a competing risk to cholecystectomy. Polytomous logistic regression was then used to examine differences in patient characteristics across outcome status at 1 year: cholecystectomy, dead without cholecystectomy, or alive without cholecystectomy. Moreover, the risk of a gallstone-related ED visit or hospital admission after discharge was estimated using the Kaplan-Meier method. RESULTS: Of 27,718 patients with acute cholecystitis, 890 (3.3%) underwent PC. The cohort was elderly with a mean (SD) age of 75 (14) years, and 14% were in the intensive care unit on the day of PC. In-hospital mortality was 5%. By 1 year after PC, only 40% had undergone cholecystectomy, while an additional 18% had died without cholecystectomy. The risk of a gallstone-related ED visit or hospital admission was 49% by 1 year after discharge. CONCLUSION: While PC is often performed with the intent of delayed cholecystectomy, less than half of patients actually go on to surgery. High mortality and likely ongoing contraindications to surgery preclude intervention in most patients, although the risk of gallstone-related ED visit or hospital admission remains high. Further prospective investigation is warranted to clarify the potential mortality and quality-of-life gains from elective cholecystectomy following PC. LEVEL OF EVIDENCE: Prognostic study, level III.
BACKGROUND: Current data on the clinical course of patients with acute cholecystitis managed with percutaneous cholecystostomy (PC) are limited by small sample size and imperfect follow-up. We present the characteristics and clinical course of a population-based cohort with acute cholecystitis managed with PC. METHODS: We designed a retrospective cohort study using administrative databases capturing all emergency department (ED) visits and hospital admissions within a geographic region with a population of more than 13 million. From all adults with a first emergency admission for acute cholecystitis from 2004 to 2011, those managed with PC were included in the cohort. The cumulative incidences of subsequent cholecystectomy and death were calculated, considering death a competing risk to cholecystectomy. Polytomous logistic regression was then used to examine differences in patient characteristics across outcome status at 1 year: cholecystectomy, dead without cholecystectomy, or alive without cholecystectomy. Moreover, the risk of a gallstone-related ED visit or hospital admission after discharge was estimated using the Kaplan-Meier method. RESULTS: Of 27,718 patients with acute cholecystitis, 890 (3.3%) underwent PC. The cohort was elderly with a mean (SD) age of 75 (14) years, and 14% were in the intensive care unit on the day of PC. In-hospital mortality was 5%. By 1 year after PC, only 40% had undergone cholecystectomy, while an additional 18% had died without cholecystectomy. The risk of a gallstone-related ED visit or hospital admission was 49% by 1 year after discharge. CONCLUSION: While PC is often performed with the intent of delayed cholecystectomy, less than half of patients actually go on to surgery. High mortality and likely ongoing contraindications to surgery preclude intervention in most patients, although the risk of gallstone-related ED visit or hospital admission remains high. Further prospective investigation is warranted to clarify the potential mortality and quality-of-life gains from elective cholecystectomy following PC. LEVEL OF EVIDENCE: Prognostic study, level III.
Authors: Peter C Ambe; Sarantos Kaptanis; Marios Papadakis; Sebastian A Weber; Stefan Jansen; Hubert Zirngibl Journal: Dtsch Arztebl Int Date: 2016-08-22 Impact factor: 5.594
Authors: Massimo Sartelli; Alain Chichom-Mefire; Francesco M Labricciosa; Timothy Hardcastle; Fikri M Abu-Zidan; Abdulrashid K Adesunkanmi; Luca Ansaloni; Miklosh Bala; Zsolt J Balogh; Marcelo A Beltrán; Offir Ben-Ishay; Walter L Biffl; Arianna Birindelli; Miguel A Cainzos; Gianbattista Catalini; Marco Ceresoli; Asri Che Jusoh; Osvaldo Chiara; Federico Coccolini; Raul Coimbra; Francesco Cortese; Zaza Demetrashvili; Salomone Di Saverio; Jose J Diaz; Valery N Egiev; Paula Ferrada; Gustavo P Fraga; Wagih M Ghnnam; Jae Gil Lee; Carlos A Gomes; Andreas Hecker; Torsten Herzog; Jae Il Kim; Kenji Inaba; Arda Isik; Aleksandar Karamarkovic; Jeffry Kashuk; Vladimir Khokha; Andrew W Kirkpatrick; Yoram Kluger; Kaoru Koike; Victor Y Kong; Ari Leppaniemi; Gustavo M Machain; Ronald V Maier; Sanjay Marwah; Michael E McFarlane; Giulia Montori; Ernest E Moore; Ionut Negoi; Iyiade Olaoye; Abdelkarim H Omari; Carlos A Ordonez; Bruno M Pereira; Gerson A Pereira Júnior; Guntars Pupelis; Tarcisio Reis; Boris Sakakhushev; Norio Sato; Helmut A Segovia Lohse; Vishal G Shelat; Kjetil Søreide; Waldemar Uhl; Jan Ulrych; Harry Van Goor; George C Velmahos; Kuo-Ching Yuan; Imtiaz Wani; Dieter G Weber; Sanoop K Zachariah; Fausto Catena Journal: World J Emerg Surg Date: 2017-07-10 Impact factor: 5.469
Authors: Cemal Kaya; Emre Bozkurt; Sinan Ömeroğlu; Pınar Yazıcı; Ufuk Oğuz İdiz; Ömer Naci Tabakçı; Özgür Bostancı; Mehmet Mihmanlı Journal: Sisli Etfal Hastan Tip Bul Date: 2018-03-26