Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy?

Autor: Víctor Martín-Gorgojo, José Luis Molina-Rodríguez, Luis Sabater, Joaquín Ortega, Dimitri Dorcaratto, Elena Muñoz-Forner, Raúl Perdomo, Marina Garcés-Albir
Rok vydání: 2020
Předmět:
Zdroj: JOURNAL OF GASTROINTESTINAL SURGERY
r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname
r-FISABIO. Repositorio Institucional de Producción Científica
r-FISABIO: Repositorio Institucional de Producción Científica
Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
ISSN: 1091-255X
Popis: Objective To investigate whether percutaneous cholecystostomy (PC) for the treatment of acute calculous cholecystitis (ACC) has better results than emergency cholecystectomy (EC) in elderly and high-risk surgical patients. Methods Patients >= 70 years and/or >= ASA-PS 3 with ACC treated with PC or EC between 2005 and 2016 were retrospectively reviewed. Both techniques were compared regarding morbi-mortality, hospital stay, complications and readmissions. A subgroup analysis in higher risk patients (>= 70 years plus >= ASA-PS 3) was also performed. A binary logistic regression analysis for outcome variables to calculate the OR was carried out. Results A total of 461 patients were included in the study. The results of PC were worse compared to EC: 30-day mortality (8.6 vs. 1.7%, OR 18.4), 90-day mortality (10.4 vs. 2.1%, OR 10.3), length of stay (days) (13.21 +/- 8.2 vs. 7.48 +/- 7.67, OR 8.7) and readmission rate (35.1 vs. 12.6%, OR 4.7). Complications were lower for PC (14 vs. 22.6%, OR 0.41), but there were no significant differences in the number of severe complications (Clavien-Dindo >= III). Higher-risk subgroup analysis (n = 193; PC = 128, EC = 65) showed similar results to the whole series. Patients with ACC for more than 3 days had more risk of severe complications in both groups (OR 2.26; OR 2.76). Conclusion PC was associated with an increased risk of mortality at 30 and 90 days, more readmissions and longer hospital stay. Although PC presents a lower risk of complications, the percentage of severe complications (Clavien-Dindo >= III) does not show significant differences.
Databáze: OpenAIRE
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