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Cholecystectomy Timing After Percutaneous Cholecystostomy in the COVID-19 Pandemic
Daniel Bent Jr, MD, Sumedh Kaul, MS, Gabriel Brat, MD
Beth Israel Deaconess Medical Center, Boston, MA
Background: Percutaneous cholecystostomy (PC) is an alternative treatment for acute cholecystitis when cholecystectomy may be initially prohibitive. Interval cholecystectomy after medical optimization is definitive management, but the ideal timing has not been identified. Our objective was to evaluate the impact of time to interval cholecystectomy on surgical outcomes during the COVID-19 pandemic when there were restrictions on non-urgent surgery.
Methods: We retrospectively reviewed our institutional experience of all adult patients undergoing PC for acute cholecystitis pre-pandemic (September 2019-March 2020), pandemic (April 2020-September 2020) and post-pandemic (September 2021-September 2022). We excluded patients with acalculous cholecystitis, history of hepatobiliary malignancy, and prior gallbladder interventions.
Results: There were 97 total patients. The cohort was elderly with a median age of 76 years and 88% had severe comorbidities (Charlson Comorbidity Index >3). A total of 41 (42.2%) patients had an interval cholecystectomy. The pre-pandemic group had significantly longer time to surgery than the pandemic and post-pandemic group respectively (median 119 days vs 55 days vs 51 days, p <0.04). Patients with PC during the pandemic were less likely to have an emergency visit prior to interval surgery (14% vs 40% pre- and 68% post-, p<0.01). There were no differences in rates of open conversion, subtotal cholecystectomy or post-operative complications.
Conclusion: Overall less than half of patients with a PC will have definitive surgery. The COVID-19 pandemic delayed the timing to interval cholecystectomy for patients who had a PC placed prior to the public health emergency, but this did not appear to affect outcomes.
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