WP4.7 - Use of cholecystostomy to manage acute cholecystitis in high risk patients in a rural hospital

Abstract Aim To evaluate outcomes after percutaneous cholecystostomy (PC) in patients with acute cholecystitis in a rural DGH. Methods Retrospective data collection on patients who underwent PC between October 2019 and January 2024. Variables collected included; Demographics, ASA grade, Charlson Comorbidity Index (CCI), inflammatory markers, length of hospital stay (LOS), complications, duration of PC, mortality and subsequent management. Results Complete data was available on 58 patients. 53.5% were male and mean age was 74±10.5years. 42(73%) patients were ASA III or above, 17(29%) had moderate CCI (3-4) and 35(60%) had severe CCI score of 5 or above. No difference noted in inflammatory markers from Day 1 to day of cholecystostomy (p=0.43) reflecting failure to antibiotic treatment. 15.5% of patients needed critical care. Average duration of PC in situ was 48 days; 11(19%) had PC in for >80 days. 27(46.5%) patients underwent cholecystograms prior to removal and 19% were abnormal. Median LOS was 12(2-159) days. 4(6.9%) patients had complications from PC insertion. 30-day and 1-year mortality was 3.5% and 5% respectively. Care episodes needed following discharge with PC in situ was 2(Mean). 17(29.3%) patients had cholecystectomy following PC removal with 12% having open conversion. Conclusions Percutaneous cholecystostomy offers a safe alternative to laparoscopic cholecystectomy in managing acute cholecystitis in high risk patients. Subsequent cholecystectomy has a higher rate of conversion to open.