Significantly more percutaneous cholecystostomy (PC) procedures were conducted in patients with acute calculous cholecystitis after the COVID-19 pandemic began vs before, according to a study in the Journal of Vascular and Interventional Radiology.
The multicenter, retrospective study assessed mortality and readmission rates in consecutive patients who had a PC for acute calculous cholecystitis from January 1, 2019, to December 31, 2020. In the UK, the national COVID-19 lockdown began on March 26, 2020. The patients were categorized into pre- or post-COVID-19 groups based on the date of their PC.
The primary outcomes were 30-day readmission and 30-day mortality.
A total of 1186 patients (men, 53.6%; median age [range], 75 [24-102] years) who had a PC in 36 UK hospitals were included and followed for a minimum of 6 months. A majority of the participants (66.3%) had a PC as the definitive treatment for acute calculous cholecystitis, owing to comorbidities, vs 31.3% who had the procedure as a bridge to planned future surgery.
The patients’ median length of stay was 13 days (range, 1-338). Of the cohort, 128 patients (10.8%) were admitted to a high dependency unit, and 45 patients (3.8%) were admitted to an intensive care unit. The inpatient mortality rate was 8.6%, the overall 30-day readmission rate was 46.0%, and the 6-month readmission rate was 69.8%. Participants who had PC as a definitive treatment had significantly higher readmission rates (56.2% vs 39.6%, P <.001).
The 30-day, 90-day, and 6-month mortality rates were 9.1%, 14.9%, and 19.3% respectively. The 30-day mortality was significantly increased among patients who had a PC as definitive treatment (18.7% vs 5.3%, P <.001).
After the COVID-19 pandemic began, significantly more PCs were performed vs before the pandemic (61.3 per month vs 37.9 per month, P <.001). A higher percentage of patients presented with complicated acute calculous cholecystitis during the post–COVID-19 period vs in the pre-COVID-19 period (49.9% vs 40.9%, P =.007). The 30-day mortality rate was 7.3% in the pre-COVID-19 period vs 11.1 in the post-COVID-19 period (P =.039). The 30-day readmission rate was 46.1% in the pre-COVID period vs 45.9% in the post-COVID period (P =.98).
A significantly greater 90-day mortality rate was observed in the centers that performed fewer than 30 cholecystostomies per year vs those that performed over 60 per year (19.3% vs 11.0%, P =.006). Tertiary hospitals conducted significantly more PCs per 100 beds (9 vs 3) and a greater proportion of PCs as a bridge to surgery (50.5% vs 22.8%) compared with district general hospitals.
Study limitations include the retrospective design and a lack of detailed information regarding patient comorbidities. In addition, ideally, the analysis would have included all patients admitted with acute calculous cholecystitis, regardless of management, noted the researchers.
“In conjunction with previous literature, it is clear that the appropriate patient for cholecystostomy is not well or uniformly appreciated, leading to wide variation and increased usage,” the study authors wrote. “Prospective, randomized, multicenter studies are required in order to further assess the appropriateness of PC and ideal management of patients following PC.”
MacCormick A, Jenkins P, Zhong J, et al. Nationwide outcomes following percutaneous cholecystostomy for acute calculous cholecystitis and the impact of COVID-19: results of the Multicentre Audit of Cholecystostomy and Further Interventions (MACAFI). J Vasc Interv Radiol. Published online October 17, 2022. doi:10.1016/j.jvir.2022.10.021