The Impact of Percutaneous Cholecystostomy Timing on Mortality and Morbidity in High-Risk Patients With Acute Calculous Cholecystitis
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, cilt.36, sa.2, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 36 Sayı: 2
- Basım Tarihi: 2026
- Doi Numarası: 10.1097/sle.0000000000001431
- Dergi Adı: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
- Anahtar Kelimeler: early placement, high-risk patients, length of hospital stay, mortality, percutaneous cholecystostomy
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
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.