480 Clinical outcome of patients underwent cholecystostomies for acute gall-bladder related pathologies

Abstract

Percutaneous cholecystostomy is an important and effective temporising procedure in patients with acute cholecystitis who are too unwell to undergo early cholecystectomy. We are seeing a rising number of cholecystostomies performed during the pandemic due to various reasons. However, evidence regarding drain indication, timing and management is lacking with varied practice within and between trusts. We have conducted this study to understand current practice employed at our unit and associated patient outcomes. In this retrospective study, we identified 138 patients who underwent image-guided percutaneous cholecystostomy between 1st January 2020 and 31st July 2022 in all hospitals within our trust. Data was collected from electronic records including drain details, immediate and late complications, biliary-related morbidity and mortality, subsequent re-admissions and definitive management. This is one of the largest studies ever conducted on cholecystostomies. Median length of time with a drain in situ was 35 days (IQR 28 days). 13 (9.8%) experienced minor immediate complications including pain during and after insertion, 51 (3.8%) experienced late complications including formation of cholecysto-cutaneous fistulous tracts and drain site infections. Hospital mortality secondary to biliary pathology was 6.8%. 28.6% had undergone definitive treatment at time of writing (median wait-time 23.5 weeks) and 25.6% were still awaiting a procedure. 29 (21.8%) patients had at least one re-admission related to their gallbladder pathology, with an average admission length of 15 days. No association was found between length of drain in situ and rates of complication and readmissions. The substantial mortality and readmission rates warrant a greater need for early/extra cholecystectomy lists in this era of gall-bladder pathologies.