Comorbidity Burden as a Determinant of Treatment Pathway After Percutaneous Cholecystostomy Tube Placement for Acute Cholecystitis: Experience From an Appalachian Tertiary Referral Center

Comorbidity burden in patients with acute cholecystitis (AC) managed by percutaneous cholecystostomy tube (PCT) placement may determine whether patients progress to cholecystectomy (CCY) or require ongoing non-operative management. This retrospective observational case series examined 139 patients admitted with PCT placement for AC at a rural Appalachian tertiary referral center between October 2020 and March 2025. The most prevalent comorbidities among these patients were hypertension (79.9%), smoking (61.2%), and hyperlipidemia (47.5%). Of the 139 patients, 31.7% (n = 44) underwent subsequent CCY and had 78.7% lower 6-month mortality compared to those managed non-operatively ( P < .001). Patients progressing to CCY had significantly lower Charlson Comorbidity Index (CCI) scores (3.89 vs. 5.57, P = .05) and were significantly less likely to have active cancer ( P = .002), COPD ( P = .001), or CHF ( P = 0.032). In resource-constrained environments where advanced endoscopic alternatives are unavailable, these comorbidity profiles can guide preoperative risk stratification and inform individualized counseling regarding anticipated treatment pathways after PCT.