384 A 5-Year Single-Centre Retrospective Review of Emergency Percutaneous Cholecystostomy in Acute Cholecystitis: Evaluating Outcomes and Clinical Practice

Abstract Aim Acute Cholecystitis can be a challenging condition to manage in the frail and comorbid population. Cholecystostomy offers a viable alternative to surgery in patients who fail non-operative management. We conducted a service review to assess our short-term outcomes in patients treated by Cholecystostomy with the goal of developing a protocol to ensure safe delivery of care. Method We retrospectively reviewed patients who underwent emergency image-guided percutaneous cholecystostomy for source control in acute cholecystitis from April 2019 – August 2024. Key metrics assessed included patient demographics, Level 2-3 escalation status, antimicrobial escalation, drain follow-up, complications, 30-day mortality, length of stay (LOS), and re-admission. Analysis was performed using MS Excel. Results 104 patients underwent emergency percutaneous cholecystectomy for radiologically confirmed cholecystitis. Antibiotics were escalated pre-procedure in 59.6% of cases, and 15.4% required Level 2/3 care post-procedure. The mean time to intervention was 3.5 days (SD 3.5) from admission. Drain-related complications occurred in 26.4%, with only 29.8% receiving a post-procedural tubogram. The mean post-procedure length of stay was 20.7 days (SD 20.3), with a 12.9% readmission rate and 7.7% requiring drain re-insertion. The 30-day mortality rate was 5.8%. Cholecystectomy was later performed in 30.7% of patients, with a postoperative complication rate of 21.9%. Conclusions Our study demonstrated timely insertion of drains and low mortality rates, whilst suggesting improvements to be made in post-procedure/follow-up care and antibiotic escalation. From our results, we will develop a streamlined protocol to aid with the identification of patients who would benefit from cholecystostomies while minimising post-procedural complications and reducing follow-up and readmission.