ABSTRACT
Background: The Royal Infirmary of Edinburgh (RIE), receives 10,000 emergency surgery consults annually. Typically 800 patients each year require acute cholecystectomy. Surgically unfit patients may undergo cholecystostomy insertion. Our audit aimed to assess the efficacy and health economics of this treatment. Method(s): A national radiology database search identified 86 cholecystostomy procedures performed at the RIE, between June 2018 and May 2020. Clinical notes were reviewed to obtain specific surgical and radiological data to input into a large dataset, allowing retrospective analysis. Result(s): During the study period approximately 2,800 patients underwent cholecystectomy and 1,600 of these were acute cholecystectomies. 82 patients (5% of acute cholecystectomies) underwent cholecystostomy. Cholecystostomy procedural morbidity was 12% (5% Grade III Clavien-Dindo or above). Figure 1 summarises patient follow up. Outpatient appointments for cholecystostomy removal occur 8 weeks after drain insertion. 11% of patients died on initial presentation and 6% had no appointment due to the COVID-19 pandemic. 41% of patients re-presented before their appointment, at a median of 30 days after discharge. Drain-related issues made up half of these consults and 3 patients underwent emergency surgery. Another 41% attended their appointment without prior issue, with 85% undergoing drain removal. 13% of patients re-presented after their drains had been removed, with 4% requiring reinsertion. Conclusion(s): Cholecystostomy treatment is associated with significant burdens in terms of morbidity for patients and health resources for providers. Alternative procedures such as endoscopic ultrasound gallbladder drainage require evaluation and may have potential to alleviate these burdens and improve patient outcomes. [Formula presented] Copyright © 2022