Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: A large multicenter outcome study

Anton Simorov, Ajay Ranade, Jeremy Parcells, Abhijit Shaligram, Valerie Shostrom, Eugene Boilesen, Matthew R Goede, Dmitry Oleynikov

Research output: Contribution to journalArticle

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Abstract

Background Morbidity and mortality are very high for critically ill patients who develop acute acalculous cholecystitis (AAC). The aim of this study was to compare outcomes in extremely ill patients with AAC treated with percutaneous cholecystostomy (PC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC), which were also analyzed together in the LC-plus-OC (LO) group. Methods Discharge data from the University HealthSystem Consortium database were accessed using International Classification of Diseases codes. The University HealthSystem Consortium's Clinical Data Base/Resource Manager allows member hospitals to compare patient-level, risk-adjusted outcomes. Multivariate regression models for extremely ill patients undergoing PC or LO for the diagnosis of AAC were created and analyzed. Results A total of 1,725 extremely ill patients were diagnosed with AAC between October 2007 and June 2011. Patients undergoing PC (n = 704) compared with the LO group (n = 1,021) showed decreased morbidity (5.0% with PC vs 8.0% with LO, P <.05), fewer intensive care unit admissions (28.1% with PC vs 34.6% with LO, P <.05), decreased length of stay (7 days with PC vs 8 days with LO, P <.05), and lower costs ($40,516 with PC vs $53,011 with LO, P <.05). Although perioperative outcomes of PC compared with LC were statistically similar, PC had lower costs compared with LC ($40,516 vs 51,596, P <.005). Multivariate regression analysis showed that LC (n = 822), compared with OC (n = 199), had lower mortality (odds ratio [OR],.3; 95% confidence interval [CI],.1 to.6), lower morbidity (OR,.4; 95% CI,.2 to.7), reduced intensive care unit admission (OR,.3; 95% CI,.2 to.5), and similar 30-day readmission rates (OR, 1.0; 95% CI,.6 to 1.5). Also, decreased length of stay (7 days with LC vs 8 days with OC) and costs ($51,596 with LC vs $61,407 with OC) were observed, with a 26% conversion rate to an open procedure. Conclusions On the basis of this experience, extremely ill patients with AAC have superior outcomes with PC. LC should be performed in patients in whom the risk for conversion is low and in whom medical conditions allow. These results show PC to be a safe and cost-effective bridge treatment strategy with perioperative outcomes superior to those of OC.

Original languageEnglish (US)
Pages (from-to)935-941
Number of pages7
JournalAmerican journal of surgery
Volume206
Issue number6
DOIs
StatePublished - Dec 1 2013

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Cholecystostomy
Acalculous Cholecystitis
Cholecystectomy
Multicenter Studies
Laparoscopic Cholecystectomy
Outcome Assessment (Health Care)
Acute Cholecystitis
Odds Ratio
Confidence Intervals
Costs and Cost Analysis
Morbidity
Intensive Care Units
Length of Stay
Databases
Conversion to Open Surgery
Mortality
International Classification of Diseases
Critical Illness

Keywords

  • Acalculous
  • Cholecystectomy
  • Cholecystitis
  • Cholecystostomy
  • Laparoscopic
  • Outcomes assessment

ASJC Scopus subject areas

  • Surgery

Cite this

Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis : A large multicenter outcome study. / Simorov, Anton; Ranade, Ajay; Parcells, Jeremy; Shaligram, Abhijit; Shostrom, Valerie; Boilesen, Eugene; Goede, Matthew R; Oleynikov, Dmitry.

In: American journal of surgery, Vol. 206, No. 6, 01.12.2013, p. 935-941.

Research output: Contribution to journalArticle

Simorov, Anton ; Ranade, Ajay ; Parcells, Jeremy ; Shaligram, Abhijit ; Shostrom, Valerie ; Boilesen, Eugene ; Goede, Matthew R ; Oleynikov, Dmitry. / Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis : A large multicenter outcome study. In: American journal of surgery. 2013 ; Vol. 206, No. 6. pp. 935-941.
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title = "Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: A large multicenter outcome study",
abstract = "Background Morbidity and mortality are very high for critically ill patients who develop acute acalculous cholecystitis (AAC). The aim of this study was to compare outcomes in extremely ill patients with AAC treated with percutaneous cholecystostomy (PC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC), which were also analyzed together in the LC-plus-OC (LO) group. Methods Discharge data from the University HealthSystem Consortium database were accessed using International Classification of Diseases codes. The University HealthSystem Consortium's Clinical Data Base/Resource Manager allows member hospitals to compare patient-level, risk-adjusted outcomes. Multivariate regression models for extremely ill patients undergoing PC or LO for the diagnosis of AAC were created and analyzed. Results A total of 1,725 extremely ill patients were diagnosed with AAC between October 2007 and June 2011. Patients undergoing PC (n = 704) compared with the LO group (n = 1,021) showed decreased morbidity (5.0{\%} with PC vs 8.0{\%} with LO, P <.05), fewer intensive care unit admissions (28.1{\%} with PC vs 34.6{\%} with LO, P <.05), decreased length of stay (7 days with PC vs 8 days with LO, P <.05), and lower costs ($40,516 with PC vs $53,011 with LO, P <.05). Although perioperative outcomes of PC compared with LC were statistically similar, PC had lower costs compared with LC ($40,516 vs 51,596, P <.005). Multivariate regression analysis showed that LC (n = 822), compared with OC (n = 199), had lower mortality (odds ratio [OR],.3; 95{\%} confidence interval [CI],.1 to.6), lower morbidity (OR,.4; 95{\%} CI,.2 to.7), reduced intensive care unit admission (OR,.3; 95{\%} CI,.2 to.5), and similar 30-day readmission rates (OR, 1.0; 95{\%} CI,.6 to 1.5). Also, decreased length of stay (7 days with LC vs 8 days with OC) and costs ($51,596 with LC vs $61,407 with OC) were observed, with a 26{\%} conversion rate to an open procedure. Conclusions On the basis of this experience, extremely ill patients with AAC have superior outcomes with PC. LC should be performed in patients in whom the risk for conversion is low and in whom medical conditions allow. These results show PC to be a safe and cost-effective bridge treatment strategy with perioperative outcomes superior to those of OC.",
keywords = "Acalculous, Cholecystectomy, Cholecystitis, Cholecystostomy, Laparoscopic, Outcomes assessment",
author = "Anton Simorov and Ajay Ranade and Jeremy Parcells and Abhijit Shaligram and Valerie Shostrom and Eugene Boilesen and Goede, {Matthew R} and Dmitry Oleynikov",
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language = "English (US)",
volume = "206",
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T1 - Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis

T2 - A large multicenter outcome study

AU - Simorov, Anton

AU - Ranade, Ajay

AU - Parcells, Jeremy

AU - Shaligram, Abhijit

AU - Shostrom, Valerie

AU - Boilesen, Eugene

AU - Goede, Matthew R

AU - Oleynikov, Dmitry

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Background Morbidity and mortality are very high for critically ill patients who develop acute acalculous cholecystitis (AAC). The aim of this study was to compare outcomes in extremely ill patients with AAC treated with percutaneous cholecystostomy (PC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC), which were also analyzed together in the LC-plus-OC (LO) group. Methods Discharge data from the University HealthSystem Consortium database were accessed using International Classification of Diseases codes. The University HealthSystem Consortium's Clinical Data Base/Resource Manager allows member hospitals to compare patient-level, risk-adjusted outcomes. Multivariate regression models for extremely ill patients undergoing PC or LO for the diagnosis of AAC were created and analyzed. Results A total of 1,725 extremely ill patients were diagnosed with AAC between October 2007 and June 2011. Patients undergoing PC (n = 704) compared with the LO group (n = 1,021) showed decreased morbidity (5.0% with PC vs 8.0% with LO, P <.05), fewer intensive care unit admissions (28.1% with PC vs 34.6% with LO, P <.05), decreased length of stay (7 days with PC vs 8 days with LO, P <.05), and lower costs ($40,516 with PC vs $53,011 with LO, P <.05). Although perioperative outcomes of PC compared with LC were statistically similar, PC had lower costs compared with LC ($40,516 vs 51,596, P <.005). Multivariate regression analysis showed that LC (n = 822), compared with OC (n = 199), had lower mortality (odds ratio [OR],.3; 95% confidence interval [CI],.1 to.6), lower morbidity (OR,.4; 95% CI,.2 to.7), reduced intensive care unit admission (OR,.3; 95% CI,.2 to.5), and similar 30-day readmission rates (OR, 1.0; 95% CI,.6 to 1.5). Also, decreased length of stay (7 days with LC vs 8 days with OC) and costs ($51,596 with LC vs $61,407 with OC) were observed, with a 26% conversion rate to an open procedure. Conclusions On the basis of this experience, extremely ill patients with AAC have superior outcomes with PC. LC should be performed in patients in whom the risk for conversion is low and in whom medical conditions allow. These results show PC to be a safe and cost-effective bridge treatment strategy with perioperative outcomes superior to those of OC.

AB - Background Morbidity and mortality are very high for critically ill patients who develop acute acalculous cholecystitis (AAC). The aim of this study was to compare outcomes in extremely ill patients with AAC treated with percutaneous cholecystostomy (PC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC), which were also analyzed together in the LC-plus-OC (LO) group. Methods Discharge data from the University HealthSystem Consortium database were accessed using International Classification of Diseases codes. The University HealthSystem Consortium's Clinical Data Base/Resource Manager allows member hospitals to compare patient-level, risk-adjusted outcomes. Multivariate regression models for extremely ill patients undergoing PC or LO for the diagnosis of AAC were created and analyzed. Results A total of 1,725 extremely ill patients were diagnosed with AAC between October 2007 and June 2011. Patients undergoing PC (n = 704) compared with the LO group (n = 1,021) showed decreased morbidity (5.0% with PC vs 8.0% with LO, P <.05), fewer intensive care unit admissions (28.1% with PC vs 34.6% with LO, P <.05), decreased length of stay (7 days with PC vs 8 days with LO, P <.05), and lower costs ($40,516 with PC vs $53,011 with LO, P <.05). Although perioperative outcomes of PC compared with LC were statistically similar, PC had lower costs compared with LC ($40,516 vs 51,596, P <.005). Multivariate regression analysis showed that LC (n = 822), compared with OC (n = 199), had lower mortality (odds ratio [OR],.3; 95% confidence interval [CI],.1 to.6), lower morbidity (OR,.4; 95% CI,.2 to.7), reduced intensive care unit admission (OR,.3; 95% CI,.2 to.5), and similar 30-day readmission rates (OR, 1.0; 95% CI,.6 to 1.5). Also, decreased length of stay (7 days with LC vs 8 days with OC) and costs ($51,596 with LC vs $61,407 with OC) were observed, with a 26% conversion rate to an open procedure. Conclusions On the basis of this experience, extremely ill patients with AAC have superior outcomes with PC. LC should be performed in patients in whom the risk for conversion is low and in whom medical conditions allow. These results show PC to be a safe and cost-effective bridge treatment strategy with perioperative outcomes superior to those of OC.

KW - Acalculous

KW - Cholecystectomy

KW - Cholecystitis

KW - Cholecystostomy

KW - Laparoscopic

KW - Outcomes assessment

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