Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients
Emergency cholecystectomy for acute cholecystitis (AC) is associated with high morbidity and mortality rates in elderly patients with significant comorbidities. The aim of this study was to evaluate percutaneous cholecystostomy for AC in elderly patients with various coexisting diseases. We retrospe...
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doaj-d5437c67021b47209e5f794629cc36412020-11-25T01:22:57ZengWileyKaohsiung Journal of Medical Sciences1607-551X2016-10-01321051852510.1016/j.kjms.2016.08.006Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patientsWei-Chen Lin0Chen-Wang Chang1Cheng-Hsin Chu2Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, TaiwanDivision of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, TaiwanDivision of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, TaiwanEmergency cholecystectomy for acute cholecystitis (AC) is associated with high morbidity and mortality rates in elderly patients with significant comorbidities. The aim of this study was to evaluate percutaneous cholecystostomy for AC in elderly patients with various coexisting diseases. We retrospectively reviewed the records of 4311 patients with AC treated in Mackay Memorial Hospital between the years 2000 and 2015. The clinical course of AC was compared between nonelderly (age ≤70 years) and elderly patients (age>70 years). In total, 67 elderly patients and 32 nonelderly patients received percutaneous cholecystostomy. The rate of percutaneous cholecystostomy increased between the years 2011 and 2015 (from 2.5% to 12.2%) and this procedure was more common in the elderly group (p=0.009). In addition, the comorbidities of ischemic heart disease and chronic kidney disease were higher in elderly than in nonelderly patients (p=0.014 and p=0.015, respectively). The American Society of Anesthesiologists' classification was higher in the elderly patients (p=0.001). The overall survival-free rate of recurrent cholecystitis in patients who did not receive cholecystectomy was not significantly different in the two groups. When compared with emergent cholecystectomy in high-risk elderly patients, percutaneous cholecystostomy resulted in reduced hospital stay and morbidity (p=0.002 and p=0.013, respectively). Our results demonstrate that percutaneous cholecystostomy has become a common and early treatment for AC in high-risk elderly patients with ischemic heart disease or chronic kidney disease. Identifying such patients will possibly improve clinical outcomes, reduce hospital stay and morbidity, and facilitate delayed laparoscopic cholecystectomy.http://www.sciencedirect.com/science/article/pii/S1607551X16301619Acute cholecystitisElderlyPercutaneous cholecystostomy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Wei-Chen Lin Chen-Wang Chang Cheng-Hsin Chu |
spellingShingle |
Wei-Chen Lin Chen-Wang Chang Cheng-Hsin Chu Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients Kaohsiung Journal of Medical Sciences Acute cholecystitis Elderly Percutaneous cholecystostomy |
author_facet |
Wei-Chen Lin Chen-Wang Chang Cheng-Hsin Chu |
author_sort |
Wei-Chen Lin |
title |
Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients |
title_short |
Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients |
title_full |
Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients |
title_fullStr |
Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients |
title_full_unstemmed |
Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients |
title_sort |
percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients |
publisher |
Wiley |
series |
Kaohsiung Journal of Medical Sciences |
issn |
1607-551X |
publishDate |
2016-10-01 |
description |
Emergency cholecystectomy for acute cholecystitis (AC) is associated with high morbidity and mortality rates in elderly patients with significant comorbidities. The aim of this study was to evaluate percutaneous cholecystostomy for AC in elderly patients with various coexisting diseases. We retrospectively reviewed the records of 4311 patients with AC treated in Mackay Memorial Hospital between the years 2000 and 2015. The clinical course of AC was compared between nonelderly (age ≤70 years) and elderly patients (age>70 years). In total, 67 elderly patients and 32 nonelderly patients received percutaneous cholecystostomy. The rate of percutaneous cholecystostomy increased between the years 2011 and 2015 (from 2.5% to 12.2%) and this procedure was more common in the elderly group (p=0.009). In addition, the comorbidities of ischemic heart disease and chronic kidney disease were higher in elderly than in nonelderly patients (p=0.014 and p=0.015, respectively). The American Society of Anesthesiologists' classification was higher in the elderly patients (p=0.001). The overall survival-free rate of recurrent cholecystitis in patients who did not receive cholecystectomy was not significantly different in the two groups. When compared with emergent cholecystectomy in high-risk elderly patients, percutaneous cholecystostomy resulted in reduced hospital stay and morbidity (p=0.002 and p=0.013, respectively). Our results demonstrate that percutaneous cholecystostomy has become a common and early treatment for AC in high-risk elderly patients with ischemic heart disease or chronic kidney disease. Identifying such patients will possibly improve clinical outcomes, reduce hospital stay and morbidity, and facilitate delayed laparoscopic cholecystectomy. |
topic |
Acute cholecystitis Elderly Percutaneous cholecystostomy |
url |
http://www.sciencedirect.com/science/article/pii/S1607551X16301619 |
work_keys_str_mv |
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