Early Percutaneous Cholecystostomy in Severe Acute Cholecystitis Reduces the Complication Rate and Duration of Hospital Stay

Chou, Chen-Liang; Lee, Kuei–Chuan; Chan, Che‐Chang; Perng, Cherng-Kang; Chen, Chun-Ku; Fang, Wen-Liang; Lin, Hong-Da

doi:10.1097/md.0000000000001096

Cited by 56 publications

(49 citation statements)

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“…However, our multivariate analysis showed that not old age, but a higher serum Cr level on admission (≥2.0 mg/dL) was the only independent predictor for the in‐hospital mortality. Consistent with the present findings, a study from Taiwan also showed that a higher serum Cr level (≥1.5 mg/dL) was an independent risk factor for in‐hospital mortality in patients with severe AC undergoing percutaneous drainage . A recent report from Italy showed that end‐stage renal disease was an independent risk factor for complex laparoscopic cholecystectomy, defined as gallbladder wall rupture and/or bleeding .…”

Section: Discussionsupporting

confidence: 90%

Clinical characteristics and short‐term outcomes in patients with acute cholecystitis over aged >80 years

Akasu

Kinoshita

Imai

et al. 2018

Geriatrics Gerontology Int

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Aim We investigated the clinical characteristics and short‐term outcomes in acute cholecystitis (AC) patients aged ≥80 years. We therefore sought to determine the ideal treatment for elderly patients with AC. Methods We retrospectively evaluated 253 patients with AC. The patients were divided into two groups according to their age: elderly group (n = 77, aged ≥80 years) and non‐elderly group (n = 176, aged <80 years). We compared the clinical characteristics, in‐hospital mortality and recurrence of cholecystitis within 6 months between the two groups. The predictive factors for in‐hospital mortality were also assessed. Results The elderly group had more severe comorbidities (P = 0.0055), higher severity grade of AC (P = 0.00071) and higher in‐hospital mortality (P = 0.029) than the non‐elderly group. The multivariate analysis showed that the serum creatinine level (hazard ratio 12.43; P = 0.002) was independently associated with the in‐hospital mortality. The elderly group (20.8%) underwent subsequent cholecystectomy less frequently than the non‐elderly group (63.2%; P < 0.0001). The recurrence rate of AC was comparable between the two groups (P = 0.89). The proportion of patients in the elderly group who received percutaneous drainage in the latter period (64.3%) was significantly higher than in the former period (33.3%; P = 0.015). Conclusions More attention should be paid to AC patients with chronic renal disease after treatment. Percutaneous drainage might serve as a definitive treatment without subsequent cholecystectomy in elderly AC patients with various comorbidities. Geriatr Gerontol Int 2019; 19: 208–212.

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Section: Discussionsupporting

confidence: 90%

Clinical characteristics and short‐term outcomes in patients with acute cholecystitis over aged >80 years

Akasu

Kinoshita

Imai

et al. 2018

Geriatrics Gerontology Int

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“…5,6 For patients not fit for surgery, delayed percutaneous cholecystostomy drainage of more than 24 hours is associated with increased morbidity and length of hospital stay (LOS). 7 However there remains uncertainty regarding optimal timing of cholecystectomy or cholecystostomy drainage in hospitalized patients with acute cholecystitis, especially in the critically ill population. This situation presents therapeutic challenges, as not all hospitals have access to interventional radiology and acute care surgery.…”

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confidence: 99%

The impact of delayed source control and antimicrobial therapy in 196 patients with cholecystitis-associated septic shock: a cohort analysis

Karvellas

Dong

Abraldes

et al. 2019

cjs

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Background: Cholecystitis-associated septic shock carries a significant mortality. Our aim was to determine whether timing of source control affects survival in cholecystitis patients with septic shock. Methods:We conducted a nested cohort study of all patients with cholecystitisassociated septic shock from an international, multicentre database (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). Multivariable logistic regression was performed to determine associations between clinical factors and in-hospital mortality. The results were used to inform a classification and regression tree (CART) analysis that modelled the association between disease severity (APACHE II), time to source control and survival.Results: Among 196 patients with cholecystitis-associated septic shock, overall mortality was 37%. Compared with nonsurvivors (n = 72), survivors (n = 124) had lower mean admission APACHE II scores (21 v. 27, p < 0.001) and lower median admission serum lactate (2.4 v. 6.8 µmol/L, p < 0.001). Survivors were more likely to receive appropriate antimicrobial therapy earlier (median 2.8 v. 6.1 h from shock, p = 0.012). Survivors were also more likely to undergo successful source control earlier (median 9.8 v. 24.7 h from shock, p < 0.001). Adjusting for covariates, APACHE II (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.06-1.21 per increment) and delayed source control > 16 h (OR 4.45, 95% CI 1.88-10.70) were independently associated with increased mortality (all p < 0.001). The CART analysis showed that patients with APACHE II scores of 15-26 benefitted most from source control within 16 h (p < 0.0001). Conclusion:In patients with cholecystitis-associated septic shock, admission APACHE II score and delay in source control (cholecystectomy or percutaneous chole cystostomy drainage) significantly affected hospital outcomes.Contexte : Le choc septique associé à une cholécystite s'accompagne d'une mortalité significative. Notre but était de déterminer si le moment du contrôle de la source affecte la survie chez les patients atteints de cholécystite qui se trouvent en choc septique.Méthodes : Nous avons procédé à une étude de cohorte nichée regroupant tous les patients ayant présenté un choc septique associé à une cholécystite à partir d'une base de données multicentrique internationale (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). La régression logistique multivariée a été utilisée pour déterminer les liens entre les facteurs cliniques et la mortalité perhospitalière. Les résultats ont été utilisés pour éclairer une analyse par arbre de classification (CART) qui modélisait le lien entre la gravité de la maladie (APACHE II), le temps nécessaire au contrôle de la source et la survie.Résultats : Parmi 196 patients souffrant d'un choc septique associé à une cholécystite, la mortalité globale a été de 37 %. Comparativement aux patients décédés (n = 72), les survivants (n = ...

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“…Therefore, the parameters discussed above affected hospitalization duration and cost-effectivity. A study by Chou et al [10] and Kapan et al [27] indicated that patients who underwent PC had decreased hospitalization duration. In this study, we also investigated the postoperative hospitalization duration between the groups and found that patients who underwent PC plus cholecystectomy had shorter hospitalization duration than those who underwent cholecystectomy alone.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] PC is being preferred as a bridge treatment before cholecystectomy or a definitive non-surgical treatment method for AC in elderly patients. [2,[10][11][12] In the…”

mentioning

confidence: 99%

Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis; percutaneous cholecystostomy

Zeren¹,

Bayhan²,

Koçak³

et al. 2017

Ulus Travma Acil Cerrahi Derg

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Early Percutaneous Cholecystostomy in Severe Acute Cholecystitis Reduces the Complication Rate and Duration of Hospital Stay

Abstract: Supplemental digital content is available in the text

Cited by 56 publications

References 24 publications

Clinical characteristics and short‐term outcomes in patients with acute cholecystitis over aged >80 years

Clinical characteristics and short‐term outcomes in patients with acute cholecystitis over aged >80 years

The impact of delayed source control and antimicrobial therapy in 196 patients with cholecystitis-associated septic shock: a cohort analysis

Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis; percutaneous cholecystostomy

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