Perioperative outcomes of delayed laparoscopic cholecystectomy for acute calculous cholecystitis with and without percutaneous cholecystostomy
| Autor: | Jacob Rachmuth, Haggi Mazeh, Natalia Simanovski, Jonathan B. Yuval, Eran Kuchuk, Ido Mizrahi, Ahmed Eid, Nadeen Abu Ata, Aviram Nissan, Gidon Almogy, Miklosh Bala |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment Cholecystitis Acute Patient Readmission Postoperative Complications Risk Factors Odds Ratio medicine Humans Percutaneous cholecystostomy Risk factor Cholecystostomy Laparoscopic cholecystectomy Aged Retrospective Studies business.industry Retrospective cohort study Odds ratio Perioperative Length of Stay Middle Aged medicine.disease Conversion to Open Surgery Surgery Logistic Models Treatment Outcome Cholecystectomy Laparoscopic Cholecystitis Female Cholecystectomy business |
| Zdroj: | Surgery. 158:728-735 |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2015.05.005 |
| Popis: | The role of percutaneous cholecystostomy (PC) in the management of patients with acute calculous cholecystitis (ACC) remains controversial. The aim of this study is to report operative outcomes in a large cohort of patients undergoing PC before their delayed laparoscopic cholecystectomy (DLC).All patients who underwent DLC because of ACC between 2003 and 2012 were included. Outcomes of patients with and without previous PC were compared.Of 639 patients who underwent DLC because of ACC at our institution during a 10-year time interval beginning 2003, 163 (25.5%) patients had PC before their DLC. Patients who underwent PC were older (64 ± 1 years vs 48 ± 0.8 years, P.001) and had more comorbid conditions (P.001). Accumulated duration of stay was longer in the PC group (16.2 ± 0.4 days vs 9.7 ± 0.1 days, P.001). Rate of conversion to open procedure was greater in the PC group (11% vs 4%, P = .001) and operative time was longer (142 ± 4 minutes vs 107 ± 4 minutes, P.001). Patients in the PC group had a greater rate of biliary-related complications (10% vs 4%, P = .003) and surgical-site infections; both superficial (5% vs 1%, P = .004) and deep (7% vs 3%, P = .04). On multivariable analysis PC was an independent risk factor for conversion to open cholecystectomy (odds ratio 2.67 95% CI 1.18-6.72) as well as to biliary-related complications (odds ratio 4.85 95% CI 1.57-14.92).DLC for ACC in patients with previous PC is associated with longer duration of stay, more readmissions, and, most importantly, greater conversion rate, biliary related complications, and surgical-site infections. |
| Databáze: | OpenAIRE |
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