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Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy?
- Source :
- JOURNAL OF GASTROINTESTINAL SURGERY, r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA, instname, r-FISABIO. Repositorio Institucional de Producción Científica, r-FISABIO: Repositorio Institucional de Producción Científica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
- Publication Year :
- 2020
- Publisher :
- Springer Verlag, 2020.
-
Abstract
- Objective To investigate whether percutaneous cholecystostomy (PC) for the treatment of acute calculous cholecystitis (ACC) has better results than emergency cholecystectomy (EC) in elderly and high-risk surgical patients. Methods Patients >= 70 years and/or >= ASA-PS 3 with ACC treated with PC or EC between 2005 and 2016 were retrospectively reviewed. Both techniques were compared regarding morbi-mortality, hospital stay, complications and readmissions. A subgroup analysis in higher risk patients (>= 70 years plus >= ASA-PS 3) was also performed. A binary logistic regression analysis for outcome variables to calculate the OR was carried out. Results A total of 461 patients were included in the study. The results of PC were worse compared to EC: 30-day mortality (8.6 vs. 1.7%, OR 18.4), 90-day mortality (10.4 vs. 2.1%, OR 10.3), length of stay (days) (13.21 +/- 8.2 vs. 7.48 +/- 7.67, OR 8.7) and readmission rate (35.1 vs. 12.6%, OR 4.7). Complications were lower for PC (14 vs. 22.6%, OR 0.41), but there were no significant differences in the number of severe complications (Clavien-Dindo >= III). Higher-risk subgroup analysis (n = 193; PC = 128, EC = 65) showed similar results to the whole series. Patients with ACC for more than 3 days had more risk of severe complications in both groups (OR 2.26; OR 2.76). Conclusion PC was associated with an increased risk of mortality at 30 and 90 days, more readmissions and longer hospital stay. Although PC presents a lower risk of complications, the percentage of severe complications (Clavien-Dindo >= III) does not show significant differences.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Cholecystitis, Acute
Subgroup analysis
Lower risk
medicine
Acute cholecystitis
Cholecystitis
Percutaneous cholecystostomy
Humans
Cholecystectomy
Cholecystostomy
Aged
Retrospective Studies
business.industry
Gastroenterology
acute
medicine.disease
Surgery
Treatment Outcome
business
Surgical patients
Subjects
Details
- ISSN :
- 1091255X
- Database :
- OpenAIRE
- Journal :
- JOURNAL OF GASTROINTESTINAL SURGERY, r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA, instname, r-FISABIO. Repositorio Institucional de Producción Científica, r-FISABIO: Repositorio Institucional de Producción Científica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
- Accession number :
- edsair.doi.dedup.....0ed268d7521af8a54fb5922e25395666