Non-operative management of cirrhotic patients with acute calculous cholecystitis: How effective is it?

Abstract

Introduction: Nonoperative management (NOM) of acute calculous cholecystitis (ACC) in patients with cirrhosis was proposed. We examined the outcomes of cirrhotic patients with ACC treated with cholecystectomy compared to NOM.

Methods: We analyzed the 2017-Nationwide Readmissions Database including cirrhotic patients with ACC. Patients were stratified: cholecystectomy, percutaneous cholecystostomy (PCT), and antibiotics only.

Primary outcomes: complications, failure of NOM.

Secondary outcomes: mortality, length of stay (LOS), and charges.

Results: 3454 patients were identified. 1832 underwent cholecystectomy, 360 PCT, and 1262 were treated with antibiotics. PCT patients had higher mortality 16.9% vs. the antibiotics group 10.9% vs. cholecystectomy group 4.2%. PCT patients had longer LOS, but lower charges compared to the operative group. Failure of NOM was 28.2%. On regression, PCT was associated with mortality.

Conclusion: ACC remains a morbid disease in cirrhosis patients. One in three failed NOM, had longer LOS, and higher mortality. Further studies are warranted to identify predictors of NOM failure.

Level of evidence: Level III, prognostic.

Keywords: Cholecystectomy; Liver cirrhosis; Percutaneous cholecystostomy.