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

Table 1 Baseline characteristics of patients undergoing percutaneous cholecystostomy (n = 174)

Variables of interest	n (%), mean (SD) or median (IQR)
Demographics
Age, mean (SD), years	71.7 (15.8)
Gender
Female	92 (53)
Male	82 (47)
Race
Hispanic	50 (29)
White	49 (28)
Asian	49 (28)
Black	17 (10)
Other	9 (5)
Comorbidities
Hypertension	124 (71)
Diabetes	85 (49)
Clinical status
Median CCI (IQR)	5 (4–7)
ICU admission	50 (29)
Antibiotics
Piperacillin/tazobactam	83 (48)
Cefoxitin	25 (14)
Ceftriaxone	10 (6)
Cefepime	7 (4)
Ampicillin/sulbactam	4 (2)
Vancomycin	39 (22)
Ciprofloxacin	13 (7)
Metronidazole	32 (18)
Ertapenem	2 (1)
Meropenem	11 (6)
Aztreonam	13 (7)
Doxycycline	7 (4)

IQR: Interquartile range; CCI: Charlson Comorbidity Index; ICU: Intensive care unit.

Table 2 Blood and bile culture data of patients undergoing percutaneous cholecystostomy (n = 174), n (%)

Microorganism	Blood culture	Bile culture
Escherichia coli	14 (8)	36 (21)
Enterococcus species	3 (2)	18 (10)
Klebsiella pneumoniae	6 (3)	26 (15)
Enterobacter	1 (1)	9 (5)
Acinetobacter	0 (0)	3 (2)
Clostridium perfrigens	2 (1)	3 (2)
No growth	125 (72)	61 (35)

Table 3 Covariate analysis conducted based on percutaneous cholecystostomy placement status (n = 174), n (%)

Characteristic	Early (n = 125)	Late (n = 49)	SMD: Early vs late
Age	75 (65, 85)	74 (64, 81)	-0.13 (-0.47, 0.21)
CCI	5.00 (3.00, 6.00)	6.50 (4.00, 8.00)	-0.57 (-0.92, -0.23)
Cholecystitis type			0.30 (-0.04, 0.64)
Acalculous	14 (11)	1 (2)	0.30 (-0.04, 0.64)
Calculous	111 (89)	48 (98)	-0.30 (-0.64, 0.04)
ICU status			0.08 (-0.26, 0.42)
ICU	34 (27.0)	16 (33)	-0.08 (-0.42, 0.26)
Non-ICU	91 (73.0)	33 (67)	0.08 (-0.26, 0.42)
Bile culture			0.60 (0.25, 0.95)
Negative	35 (28)	26 (53)	-0.60 (-0.95, -0.25)
Positive	90 (72)	23 (47)	0.60 (0.25, 0.95)
Blood culture			0.41 (0.05, 0.76)
Negative	85 (68)	40 (82)	-0.41 (-0.76, -0.05)
Positive	40 (32)	9 (18)	0.41 (0.05, 0.76)

ICU: Intensive care unit; CCI: Charlson Comorbidity Index; SMD: Standardized mean differences.

Table 4 Outcomes by timing of percutaneous cholecystostomy (n = 174)

Outcome	Early PCT (≤ 4 days) (n = 125)	Late PCT (> 4 days) (n = 49)
Catheter duration (days), median (IQR)	40 (30-60)	55 (45-80)
Overall mortality	15% (19/125)	35% (17/49)
Catheter removal	14% (17/125)	12% (6/49)
Interval LC performed	38% (48/125)	16% (8/49)

Outcomes stratified by timing of percutaneous cholecystostomy placement. PCT: Percutaneous cholecystostomy; LC: Laparoscopic cholecystectomy.

Table 5 Outcomes by intensive care unit status (n = 174)

Outcome	ICU patients (n = 50)	Non-ICU patients (n = 124)
Catheter duration (days), median (IQR)	60 (40-85)	42 (32-55)
Overall mortality	22% (11/50)	20% (25/124)
Catheter removal	12% (6/50)	14% (17/124)
Interval LC performed	22% (11/50)	36% (45/124)

Outcomes stratified by timing of percutaneous cholecystostomy placement. LC: Laparoscopic cholecystectomy; ICU: Intensive care unit.

Table 6 Outcomes by type of cholecystitis (calculous vs acalculous)

Outcome	Calculous (n = 159)	Acalculous (n = 15)
Catheter duration (days), median (IQR)	49.5 (30-85)	47 (9-94)
Overall mortality (%)	22.6 (36/159)	0 (0/15)
Catheter removal (%)	13.2 (21/159)	1.5 (2/15)
Interval LC performed (%)	31 (49/159)	47 (7/15)

Outcomes stratified by timing of percutaneous cholecystostomy placement. LC: Laparoscopic cholecystectomy.

Table 7 Covariate analysis conducted based on follow-up status (n = 174), n (%)

Characteristic	Censored (n = 138)	Expired (n = 36)	SMD: Early vs late
Age	74 (61, 83)	79 (72, 88)	-0.69 (-1.07, -0.32)
CCI	5.00 (3.00, 6.00)	6.50 (5.50, 7.00)	-0.81 (-1.19, -0.43)
Cholecystitis type			0.45 (0.08, 0.82)
Acalculous	15 (11)	0 (0)	0.45 (0.08, 0.82)
Calculous	123 (89)	36 (100)	-0.45 (-0.82, -0.08)
ICU			0.06 (-0.31, 0.43)
ICU	39 (28)	11 (31)	-0.06 (-0.43, 0.31)
Non-ICU	99 (72)	25 (69)	0.06 (-0.31, 0.43)
Bile culture			0.18 (-0.19, 0.55)
Negative	50 (36)	11 (31)	0.18 (-0.19, 0.55)
Positive	88 (64)	25 (69)	-0.18 (-0.55, 0.19)
Blood culture			0.01 (-0.37, 0.38)
Negative	97 (70)	28 (78)	0.01 (-0.37, 0.38)
Positive	41 (30)	8 (22)	-0.01 (-0.38, 0.37)

ICU: Intensive care unit; CCI: Charlson Comorbidity Index.

Table 8 Adjusted Cox proportional hazards model examining the effect of percutaneous cholecystostomy placement time on mortality (n = 174)

Characteristic	HR	95%CI	P value
PCT placement interval
Early
Late	2.58	1.25, 5.32	0.01
Age	1.05	1.01, 1.08	0.01
Charlson Comorbidity Index	1.14	0.98, 1.32	0.09
ICU status
ICU
Non-ICU	0.85	0.39, 1.82	0.7
Blood culture
Negative
Positive	0.67	0.28, 1.60	0.4
Bile culture
Negative
Positive	2.07	0.95, 4.49	0.07

ICU: Intensive care unit; CI: Confidence interval; HR: Hazard ratio.

Table 9 Adjusted Cox proportional hazards model examining the effect of percutaneous cholecystostomy placement time on mortality in the subset of patients with calculous cholecystitis (n = 159)

Characteristic	HR	95%CI	P value
PCT placement interval
Early
Late	2.51	1.21-5.18	0.01
Age	1.05	1.01-1.09	0.01
Charlson Comorbidity Index	1.11	0.96-1.29	0.2
ICU status
ICU
Non-ICU	0.93	0.44-2.00	0.9
Blood culture
Negative
Positive	0.67	0.28-1.60	0.4
Bile culture
Negative
Positive	2.21	1.02-4.79	0.04

PCT: Percutaneous cholecystostomy; CI: Confidence interval; HR: Hazard ratio; ICU: Intensive care unit.