Role of percutaneous cholecystostomy in all-comers with acute cholecystitis according to current guidelines in a general
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ORIGINAL ARTICLE
Role of percutaneous cholecystostomy in all‑comers with acute cholecystitis according to current guidelines in a general surgical unit Irene Marziali1 · Simone Cicconi1 · Fabio Marilungo1 · Michele Benedetti1 · Paolo Ciano1 · Paolo Pagano2 · Fabio D’Emidio2 · Gianluca Guercioni1 · Marco Catarci1 Received: 24 July 2020 / Accepted: 7 October 2020 © Italian Society of Surgery (SIC) 2020
Abstract Acute calculous cholecystitis (ACC) is a very common complication of gallstone-related disease. Its currently recommended management changes according to severity of disease and fitness for surgery. The aim of this observational study is to assess the short- and long-term outcomes in all-comers admitted with diagnosis of ACC, treated according to 2013 Tokyo Guidelines (TG13). A retrospective analysis was conducted on a prospectively maintained database of 125 patients with diagnosis of ACC consecutively admitted between January 2017 and September 2019, subdivided in three groups according to TG13: percutaneous cholecystostomy (PC group), cholecystectomy (CH group), and conservative medical treatment (MT group). The primary end point was a composite of morbidity and/or mortality rates; the secondary end points were ACC recurrence, readmission, need for cholecystectomy rates and overall length of hospital stay (LOS). After a median follow-up of 639 days, overall morbidity rate was 20.8% and mortality rate was 6.4%. Death was directly related to AC during the index admission in two out of eight cases. There were no significant differences in primary end point according to the treatment group. Concerning secondary end points, ACC recurrence rate was not significantly different after PC (10.0%) or MT (9.1%); the readmission rates were significantly higher (p II adverse event) and mortality (death due to any cause) rates. Primary end point was a composite of overall morbidity and/or mortality. Secondary end points were readmission (any need for hospitalization during the follow-up after the first admission), post-PC and post-MT recurrence of AC (including the need for cholecystectomy), and overall length of hospital stay (LOS) inclusive of any readmission. Gallbladder empyema at cholecystectomy, laparoscopic cholecystectomy, conversion to open surgery rates and length of the procedure were also considered among secondary end points.
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Statistical analysis
Results
All continuous values were expressed as mean ± standard deviation (SD), 95% confidence intervals of the mean (95% CI), range and median; categorical data with percentage frequencies; median and interquartile range (IQR) were presented for discrete variables. Univariable analyses were performed using cross-tabulation and Chi-square or Fisher’s exact tests for categorical data, and Mann–Whitney U test or Kruskal–Wallis test, as appropriate, for continuous or discrete variables. Concerning primary end point, due to small sample size and event rates anticipating low power, adjusted analysis was performed using a composite end point of
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