Percutaneous cholecystostomy for grade III acute cholecystitis is associated with worse outcomes

Background: The aim of the present study was to evaluate the mortality, morbidity, and readmissions associated with management of grade 3 cholecystitis in the elderly, vulnerable population. Methods: This was a retrospective cohort study of non -elective admissions for acute cholecystitis from 2010 to 2015 using the nationwide readmissions database for adults 65 years with evidence of end - organ dysfunction (grade 3) who underwent percutaneous cholecystostomy (PC), laparoscopic (LC) or open cholecystectomy (OC). Index and readmission outcomes were analyzed using logistic regression and inverse probability treatment weight analysis. Results: Of the estimated 358,624 patients, 14.9% underwent PC, 15.7% OC, and 69.4% LC. PC had signi ficantly higher odds of mortality (AOR 5.8, 95%CI 5.1-6.6), composite morbidity (AOR 3.8, 95%CI 3.5 -4.1), early (AOR 1.9, 95%CI 1.7-2.0) and intermediate (AOR 2.2, 95%CI 2.0-2.5) readmission compared to LC and OC. Conclusions: Patients undergoing cholecystostomy had higher mortality, complications, and readmission rates warranting revaluation of criteria for cholecystostomy at initial presentation. (C) 2019 Elsevier Inc. All rights reserved.