Defining endpoints in percutaneous cholecystostomy: Catheter management, patient survival, and long-term outcomes from a twelve-year retrospective study

Abstract

BACKGROUND

Percutaneous cholecystostomy (PCT) is widely used for high-risk acute cholecystitis as an alternative to emergent cholecystectomy. Despite its effectiveness, the optimal timing, catheter management, and long-term outcomes remain to be elucidated.

AIM

To characterize timing, catheter management, survival, and follow-up outcomes after PCT in a high-risk cohort.

METHODS

This single center retrospective cohort study included consecutive adult patients undergoing PCT placement for acute cholecystitis at a community hospital setting in New York between January 2012 and December 2024. The study population was grouped according to type of acute cholecystitis (calculous vs acalculous), according to the timing of PCT placement since diagnosis [early (≤ 4 days) vs late (> 4 days)], and according to level of care [intensive care unit (ICU) vs non-ICU patients]. Cox proportional hazards models were used to examine effects of PCT placement interval on mortality rates, after accounting for potential confounding factors (age, Charlson Comorbidity Index, cholecystitis type, ICU status, bile culture and blood culture data).

RESULTS

The population consisted of 174 patients who underwent PCT placement for acute cholecystitis between 2012 and 2024 at a community hospital in New York. Median time to PCT was 2 days (interquartile range 1-4). Overall, mortality was 21% (36/174) and was higher with delayed PCT (> 4 days) vs early PCT [35% (17/49) vs 15% (19/125), P = 0.001]. Catheter removal occurred in 13% (23/174), 55% (96/174) remained catheter-dependent, and 32% (56/174) had interval cholecystectomy. ICU admission was associated with prolonged catheter duration but was not associated with mortality. Kaplan-Meier analysis demonstrated a significantly higher survival rate in the early group compared with the late group (log-rank P = 0.006). In both unadjusted models and models adjusted for selected covariates, patients who had catheters placed late (> 4 days) had 2.5-fold higher risk of death than patients with early placement.

CONCLUSION

Early PCT was associated with higher survival in high-risk acute cholecystitis. High rates of catheter dependency highlight the need for standardized protocols and reassessment for definitive surgery.

Keywords: Percutaneous cholecystostomy; Acute gallstone cholecystitis; Acalculous cholecystitis; Catheter management; Cholelithiasis; Laparoscopic cholecystectomy

Core Tip: Percutaneous cholecystostomy (PCT) is commonly used as a bridge or alternative to surgery in high-risk patients with acute cholecystitis, yet optimal timing and catheter management remain uncertain. In this retrospective study of 174 patients, early PCT (≤ 4 days from diagnosis) was associated with significantly higher survival compared to delayed intervention. Despite its clinical benefit, more than half of patients remained catheter-dependent, and only one-third underwent interval cholecystectomy. These findings highlight the need for standardized PCT management protocols and structured follow-up to optimize long-term outcomes in this fragile population.