|
Back to Annual Meeting Program
Operate Another day? Increasing Utilization of Cholecystostomy Tube Drainage for Acute Cholecystitis
Elan R. Witkowski, MD, Elizaveta Ragulin-Coyne, MD, Zeling Chau, MD, Sing Chau Ng, MD, Heena Santry, MD, Shimul A. Shah, MD, Jennifer F. Tseng, MD
University of Massachusetts Medical School, Worcester, MA
Background: Since the popularization of laparoscopic cholecystectomy (LC), surgeons' comfort with open cholecystectomy (OC) as safe alternative may have diminished. Recent work has suggested that cholecystostomy tube drainage (CCT) is a safe and effective bridge to LC. We hypothesized that the use of CCT has increased while definitive management (OC and LC) has decreased in the treatment of acute cholecystitis (AC).
Methods: Patients with AC were identified in the NIS 1998-2007. Procedures were identified by ICD-9. Trends were evaluated by Cochran-Armitage. Multivariable logistic regression was performed to evaluate predictors of receiving each procedure.
Results: 2,306,649 patients (nationally-weighted) with AC were identified. Of these, 44,722(1.9%) received CCT, while 1,454,014(63%) underwent LC and 435,237(18.9%) received OC. Only 19.8% of patients who received CCT also underwent LC or OC during their admission. Over the 10-year interval, the use of OC decreased from 24.3% to 13.4%(p<0.0001), while LC rose from 59.7% to 68.1%(p<0.0001) and CCT increased from 1.0% to 2.9%(p<0.0001). The overall proportion of patients who received definitive operation (LC or OC) decreased from 83.9% to 81.5%(p<0.0001). In-hospital mortality decreased from 2.2% to 1.9% (p<0.0001). Patients who received CCT had higher Elixhauser comorbidity scores (2.2) when compared to LC(0.4) and OC(1). Older age, increasing comorbidities, male sex, later year, large/teaching hospital, and Medicare insurance were predictive of receiving CCT.
Conclusion: Utilization of open cholecystectomy and definitive management for AC have decreased significantly, concurrent with increasing utilization of cholecystostomy and decreasing mortality. Additional studies are underway to adjust for treatment selection bias and determine long-term outcomes.
Back to Annual Meeting Program
|
