United Kingdom nationwide outcomes following percutaneous cholecystostomy for acute calculous cholecystitis: results of the multicentre audit of cholecystostomy and further interventions (MACAFI)

ABSTRACT

Purpose To assess the outcomes and variations in practice on the use of percutaneous cholecystostomy (PC) in patients with acute calculous cholecystitis (ACC). Material and Methods Data on consecutive patients who underwent PC for ACC between 1st January 2019 and 31st December 2020 were collected retrospectively from 36 hospitals within the United Kingdom as part of a national multi-centre audit project conducted by the UK National Interventional Radiology Trainee Research (UNITE) Network. Results 1186 patients [636 (53.6%) males, median age (range) 75 (24-102) years] who underwent PC (66.3% definitive treatment, 31.3% bridge to surgery) were included. A greater proportion of patients presented with complicated ACC during the COVID-19 pandemic compared with before (49.9% vs. 40.9%, p=0.007) resulting in more PCs being performed (61.3 per month vs. 37.9 per month, p<0.001). More PCs were performed in tertiary centres (9 vs. 3 per 100 beds, p<0.001) with a greater proportion as a bridge to surgery (50.5% vs. 22.8%, p<0.001) compared with district general hospitals. Cholangiograms via the PC drain were performed in 538 (45.9%) patients prior to removal. Conclusion PCs were predominantly performed as a definitive management in patients with ACC who were unfit for surgery. During the COVID-19 pandemic, a greater proportion of patients presented with complicated ACC resulting in an increased use of PCs. There is a wide variation in practice regarding the use of PCs, duration of tubes left in-situ and investigations performed prior to removal.