Percutaneous cholecystostomy-tube for high-risk patients with acute cholecystitis: current practice and implications for future research

  • Ravi B. Pavurala
  • Daniel Li
  • Kyle Porter
  • Sara A. Mansfield
  • Darwin L. Conwell
  • Somashekar G. KrishnaEmail author



While cholecystectomy (CCY) is the standard of care for gallstone-related acute cholecystitis, percutaneous cholecystostomy-tube (CCYT-tube) is an alternative option in patients with significant comorbid conditions. We sought to identify immediate and longitudinal hospital outcomes of patients who underwent CCYT-tube placement and determine predictors of CCYT-tube placement and eventual CCY on a national level in the US.


We identified all adults (age ≥ 18 years) with a primary diagnosis of acute calculous cholecystitis from January to November 2013 in the Nationwide Readmissions Database (NRD). The NRD allows longitudinal follow-up of a patient for one calendar year. Outcomes of patients undergoing CCY and CCYT-tube were compared. Separate univariable and multivariable regression analyses were performed to identify predictors of CCYT-tube placement and failure to undergo subsequent CCY.


A total of 181,262 patients had an index hospitalization with acute cholecystitis where 178,095 (98.3%) patients underwent only CCY and 3167 (1.7%) patients were managed with CCYT-tubes. Among patients with CCYT-tube, 1196 (37.8%) underwent eventual CCY in 2013, while 1971 (62.2%) did not. One in five patients with CCYT-tube were readmitted within 30 days of hospital discharge. Multivariable analysis demonstrated that increasing age, male gender, coronary artery disease, cirrhosis, atrial fibrillation, diastolic congestive heart failure, and sepsis were associated with CCYT-tube placement. Longitudinal follow-up revealed that older age (OR 1.16, 95% CI 1.09–1.23), Elixhauser comorbidity score 3–4 (OR 1.94, 95% CI 1.03–3.63), cirrhosis (OR 3.28, 95% CI 1.59–6.79), and diastolic congestive heart failure (OR 2.47, 95% CI 1.33–4.60) were associated with failure to undergo subsequent CCY.


In this national survey, nearly two in three patients who receive CCYT-tube for acute cholecystitis do not get CCY during longitudinal data capture within the same calendar year. Future research needs to target novel options for drainage of the gallbladder in high-risk patient populations.


Percutaneous cholecystostomy-tube Acute calculous cholecystitis Cholecystectomy 


Author Contributions

RBP: study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and study supervision. DL: study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content. KP: statistical analysis; acquisition of data; analysis and interpretation of data; and critical revision of the manuscript for important intellectual content. SAM: critical revision of the manuscript for important intellectual content. DLC: Critical revision of the manuscript for important intellectual content. SGK: study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and study supervision.

Compliance with ethical standards


Ravi B. Pavurala, Daniel Li, Kyle Porter, Sara A. Mansfield, Darwin L. Conwell, and Somashekar G. Krishna have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2018_6634_MOESM1_ESM.docx (34 kb)
Supplementary material 1 (DOCX 34 KB)


  1. 1.
    Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L (2003) Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg 7:642–645CrossRefGoogle Scholar
  2. 2.
    Winbladh A, Gullstrand P, Svanvik J, Sandstrom P (2009) Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB 11:183–193CrossRefGoogle Scholar
  3. 3.
    Li M, Li N, Ji W, Quan Z, Wan X, Wu X, Li J (2013) Percutaneous cholecystostomy is a definitive treatment for acute cholecystitis in elderly high-risk patients. Am Surg 79:524–527Google Scholar
  4. 4.
    Gurusamy KS, Rossi M, Davidson BR (2013) Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database Syst Rev. Google Scholar
  5. 5.
    Alvino DM, Fong ZV, McCarthy CJ, Velmahos G, Lillemoe KD, Mueller PR, Fagenholz PJ (2017) Long-term outcomes following percutaneous cholecystostomy tube placement for treatment of acute calculous cholecystitis. J Ggastrointest Surg 21(5):761–769Google Scholar
  6. 6.
    Ha JP, Tsui KK, Tang CN, Siu WT, Fung KH, Li MK (2008) Cholecystectomy or not after percutaneous cholecystostomy for acute calculous cholecystitis in high-risk patients. Hepato-Gastroenterology 55:1497–1502Google Scholar
  7. 7.
    Kapan M, Onder A, Tekbas G, Gul M, Aliosmanoglu I, Arikanoglu Z, Aldemir M (2013) Percutaneous cholecystostomy in high-risk elderly patients with acute cholecystitis: a lifesaving option. Am J Hospice Palliative Care 30:167–171CrossRefGoogle Scholar
  8. 8.
    Okamoto K, Takada T, Strasberg SM, Solomkin JS, Pitt HA, Garden OJ, Buchler MW, Yoshida M, Miura F, Kimura Y, Higuchi R, Yamashita Y, Mayumi T, Gomi H, Kusachi S, Kiriyama S, Yokoe M, Lau WY, Kim MH (2013) TG13 management bundles for acute cholangitis and cholecystitis. J Hepato-Biliary-Pancreat Sci 20:55–59CrossRefGoogle Scholar
  9. 9.
    Yun SS, Hwang DW, Kim SW, Park SH, Park SJ, Lee DS, Kim HJ (2010) Better treatment strategies for patients with acute cholecystitis and American Society of Anesthesiologists classification 3 or greater. Yonsei Med J 51:540–545CrossRefGoogle Scholar
  10. 10.
    Horn T, Christensen SD, Kirkegard J, Larsen LP, Knudsen AR, Mortensen FV (2015) Percutaneous cholecystostomy is an effective treatment option for acute calculous cholecystitis: a 10-year experience. HPB 17:326–331CrossRefGoogle Scholar
  11. 11.
    Mizrahi I, Mazeh H, Yuval JB, Almogy G, Bala M, Simanovski N, Ata NA, Kuchuk E, Rachmuth J, Nissan A, Eid A (2015) Perioperative outcomes of delayed laparoscopic cholecystectomy for acute calculous cholecystitis with and without percutaneous cholecystostomy. Surgery 158:728–735CrossRefGoogle Scholar
  12. 12.
    Riall TS, Zhang D, Townsend CM Jr, Kuo YF, Goodwin JS (2010) Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. J Am Coll Surg 210:668–677, 677 – 669CrossRefGoogle Scholar
  13. 13.
    Agency for Healthcare R (2013) Healthcare Cost and Utilization Project Nationwide Readmission Database. Healthcare Cost and Utilization Project 2013.
  14. 14.
    Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27CrossRefGoogle Scholar
  15. 15.
    Anderson JE, Chang DC, Talamini MA (2013) A nationwide examination of outcomes of percutaneous cholecystostomy compared with cholecystectomy for acute cholecystitis, 1998–2010. Surg Endosc 27:3406–3411CrossRefGoogle Scholar
  16. 16.
    Gabriel RA, Sztain JF, A’Court AM, Hylton DJ, Waterman RS, Schmidt U (2018) Postoperative mortality and morbidity following non-cardiac surgery in a healthy patient population. J Anesthesia 32:112–119CrossRefGoogle Scholar
  17. 17.
    Pelavski AD, De Miguel M, Alcaraz Garcia-Tejedor G, Villarino L, Lacasta A, Senas L, Rochera MI (2017) Mortality, geriatric, and nongeriatric surgical risk factors among the eldest old: a prospective observational study. Anesthesia Analgesia 125:1329–1336CrossRefGoogle Scholar
  18. 18.
    Devereaux PJ, Sessler DI (2015) Cardiac complications in patients undergoing major noncardiac surgery. N Engl J Med 373:2258–2269CrossRefGoogle Scholar
  19. 19.
    Thulstrup AM, Sorensen HT, Vilstrup H (2001) Mortality after open cholecystectomy in patients with cirrhosis of the liver: a population-based study in Denmark. Eur J Surg Acta chirurgica 167:679–683Google Scholar
  20. 20.
    Nguyen KT, Kitisin K, Steel J, Jeyabalan G, Aggarwal S, Geller DA, Gamblin TC (2011) Cirrhosis is not a contraindication to laparoscopic cholecystectomy: results and practical recommendations. HPB 13:192–197CrossRefGoogle Scholar
  21. 21.
    Griniatsos J, Petrou A, Pappas P, Revenas K, Karavokyros I, Michail OP, Tsigris C, Giannopoulos A, Felekouras E (2008) Percutaneous cholecystostomy without interval cholecystectomy as definitive treatment of acute cholecystitis in elderly and critically ill patients. South Med J 101:586–590CrossRefGoogle Scholar
  22. 22.
    Morse BC, Smith JB, Lawdahl RB, Roettger RH (2010) Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy. Am Surg 76:708–712Google Scholar
  23. 23.
    Ginat D, Saad WE (2008) Cholecystostomy and transcholecystic biliary access. Tech Vasc Interv Radiol 11:2–13CrossRefGoogle Scholar
  24. 24.
    Kortram K, de Vries Reilingh TS, Wiezer MJ, van Ramshorst B, Boerma D (2011) Percutaneous drainage for acute calculous cholecystitis. Surg Endosc 25:3642–3646CrossRefGoogle Scholar
  25. 25.
    Itoi T, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, Ishii K, Tsuji S, Ikeuchi N, Tsukamoto S, Takeuchi M, Kawai T, Moriyasu F (2008) Endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis in whom percutaneous transhepatic approach is contraindicated or anatomically impossible (with video). Gastrointest Endosc 68:455–460CrossRefGoogle Scholar
  26. 26.
    Khan MA, Atiq O, Kubiliun N, Ali B, Kamal F, Nollan R, Ismail MK, Tombazzi C, Kahaleh M, Baron TH (2017) Efficacy and safety of endoscopic gallbladder drainage in acute cholecystitis: is it better than percutaneous gallbladder drainage? Gastrointest Endosc 85:76–87 (e73)CrossRefGoogle Scholar
  27. 27.
    Suzuki K, Bower M, Cassaro S, Patel RI, Karpeh MS, Leitman IM (2015) Tube cholecystostomy before cholecystectomy for the treatment of acute cholecystitis. JSLS 19:e2014.00200CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Center for Biostatistics, Department of Biomedical InformaticsThe Ohio State UniversityColumbusUSA
  3. 3.Division of General and Gastrointestinal SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA
  4. 4.Division of Gastroenterology, Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusUSA

Personalised recommendations