146 Percutaneous Cholecystostomy Management: A Quality Improvement Project
Annabelle White, Holly Harman, Tess Worthington, Fiona Wu, Michail Klimovskij- Surgery
Abstract
Introduction
Percutaneous Cholecystostomy (PC) drainage is used in acute calculous cholecystitis management for draining a septic source as an adjunct to antibiotic therapy, and frequently a temporising measure to interval cholecystectomy. Despite various guidelines surrounding PC insertion, there is little consensus on their subsequent management and removal – including optimal duration, investigations prior to removal, and timing of cholecystectomy.
Method
Retrospective review of all patients undergoing radiologically guided PC insertion between 1/22/21 and 2/10/22. Data collected included patient demographics, time from diagnosis to PC, duration of admission and PC in situ, investigations prior to removal, cholecystectomy, and complications.
Results
25 patients, with median 2 days from diagnosis to PC (0-25), and admission duration 6.5 days (1-25). 22 patients were discharged with PC in situ, 2 removed prior to discharge, and 1 in-hospital mortality. 33 days (1-68) median duration of PC in situ, with 11 having LFTs and 10 having cholecystogram prior to removal. 5 patients have subsequently undergone cholecystectomy, with another 5 awaiting operation date. 2 patients were readmitted following initial PC removal– both requiring further PC insertion.
Conclusion
We demonstrated considerable heterogeneity in PC management at ESHT, and subsequently introduced a consultant-body approved “Cholecystostomy Pathway” and “Cholecystostomy Passport”. This pathway outlines the journey for patients through outpatient investigations and removal – complete with ideal timeline and clinic appointments. Accompanied by the “Cholecystostomy Passport” given to patients outlining the above and providing safety netting information, we aim to standardise PC management and subsequently improve patient outcomes and experience.