Evaluation of Readmission and Cholecystectomy Requirement After Percutaneous Cholecystostomy in Acute Cholecystitis

Abstract Background This study aimed to evaluate the necessity of routine interval cholecystectomy by examining biliary-related readmission rates after catheter removal and postoperative complication rates among high-risk comorbidity patients who underwent surgical intervention following percutaneous cholecystostomy (PC) for acute calculous cholecystitis (ACC). Predictive clinical and laboratory markers for readmission were also analyzed. Methods A retrospective analysis was performed on 201 high-risk patients who underwent PC for ACC between January 2019 and January 2024, successfully completed drainage therapy, and demonstrated cystic duct patency on cholecystocholangiography at the time of catheter removal. Demographic data, Charlson Comorbidity Index (CCI) scores, Tokyo Guidelines 2018 (TG18) severity grades, laboratory markers on admission, readmission patterns and surgical outcomes/complications were evaluated over a 1-year follow-up period. Results The mean age of the study cohort was 71.80 ± 12.42 years, and the median CCI score was 5.0. According to TG18 severity grading, 11.4% were classified as Grade I, 61.1% as Grade II, and 27.4% as Grade III. Biliary-related readmission within 1 year occurred in 23.9% (n = 48) of patients, at a mean of 4.53 ± 3.27 months, with 77.08% of recurrences happening within the first 6 months. Triggers for readmission included recurrent cholecystitis (58.3%), choledocholithiasis (31.3%), and acute cholangitis (10.4%). A total of 50 patients (24.8%) underwent subsequent cholecystectomy, yielding a remarkably high postoperative complication rate of 42.0% (n = 21), including two mortalities from postoperative hemorrhage. Complication rates did not significantly differ between patients operated on electively and those operated on following a readmission event (36.4% vs. 52.9%; p = 0.261). Shorter duration of catheterization was significantly associated with higher readmission rates (p = 0.045). In multivariate logistic regression, gamma-glutamyl transferase (GGT) was isolated as an independent risk factor for readmission (OR: 1.002, 95% CI: 1.001–1.004, p = 0.048). Conclusion PC serves as an effective definitive treatment option rather than just a temporary bridge for elderly, high-risk comorbidity patients presenting with acute cholecystitis. Given the manageable readmission rates along with an exceedingly high complication profile associated with delayed surgery, routine interval cholecystectomy is unnecessary and should not be systematically recommended in this specific patient population.