90th Annual Meeting Abstracts
Use of Cholecystostomy Tube in the Management of High-Risk Patients with Acute Cholecystitis
*Maia N Sharuk, BA, *Jason T Wiseman, BA, *Anand Singla, BA, *Jennifer F Tseng, MD, MPH, Demetrius EM Litwin, MD, MBA, *Shimul A Shah, MD
University of Massachusetts Medical School, Worcester, MA
Objective: To compare an initial strategy of utilizing cholecystostomy tubes (CCT) with open cholecystectomy in high-risk surgical patients.
Design: Retrospective analysis
Setting: Hospital admission with primary diagnosis of acute cholecystitis (AC) from a tertiary care center from 1/2002-1/2007.
Patients: 923 patients admitted for AC underwent surgery. Patients who underwent laparoscopic cholecystectomy (LC; n=663), those with missing data (n=43) and metastatic GI cancer (n=72) were excluded. In all, 145 patients were included as high risk surgical patients.
Interventions: Statistical analyses with chi-square, Student’s t-test, and ANOVA
Main outcome measures: Patient demographical characteristics, procedures (medical and surgical), and post-operative outcomes.
Results: Of the 145 high-risk patients with AC, 9 underwent open cholecystectomy (OC, 1.1%), 51 underwent an open conversion (CONV, 6.3%), and 85 had a CCT (10.6%). Patients were placed into two groups: those who underwent CCT (n=85) and those that underwent OC or CONV (OC/CONV) (n=60). From 2002-2007, there has been an increase in the number of patients who had a CCT with a concomitant decrease in patients undergoing OC/CONV (p=0.04). Demographics between the two groups were not different. 52% of CCT patients had ≥ 3 comorbidities compared to 30% in OC/CONV group. CCT patients were more likely to have cardiovascular diseases and diabetes (p<0.05). 55% of patient in the CCT group underwent interval cholecystectomy in an average of 80 days post-CCT; of these, 83% underwent LC.
Conclusions: There has been an increase in the number of CCT placed in high risk surgical patients with AC compared to OC/CONV at our institution. Our results suggest that use of CCT in selected patients appears safe and allows patients to successfully undergo LC in the future.