Background

Laparoscopic cholecystectomy is the gold standard for treatment of acute cholecystitis. Percutaneous cholecystostomy (PC) drains are alternatives to cholecystectomy in critically ill patients in whom surgery carries an unacceptably high risk. Recently, several studies demonstrated a significant increase in complications in patients undergoing PC in comparison to laparoscopic cholecystectomy.

Methods

We conducted a retrospective analysis of patients who underwent PC drainage or cholecystectomy from 2014 through 2019 at our institution. We determined the rate of PC use and performed a linear regression analysis to evaluate PC utilization over time. After creating institutional guidelines and reeducating physicians on appropriate use of PC drainage in 2019, we compared PC utilization to prior years.

Results

A total of 146 PCs and 3163 cholecystectomies were performed over the study period. Of the cholecystectomies, 754 (23.8%) were performed in hospitalized patients under urgent or emergent conditions. Of the patients with acute cholecystitis, 16.2% were treated with PC. Linear regression analysis demonstrated a significant association between year and rate of PC procedures (p<0.001). The rate of PC rose from 13.8 to 22.5% between 2014 and 2018 and dropped to 10.9% (p=0.006) in 2019 after the reeducation program.

Conclusions

With a rising rate of PC utilization and in light of recent studies suggesting increased complications and healthcare costs for patients undergoing this procedure, care needs to be taken to ensure that only appropriate patients are referred for PC. Publication of institutional guidelines, resident and attending surgeon reeducation, and case review can reduce placement of unnecessary PCs.

中文翻译：

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社区医院经皮胆囊造口术的兴衰：能否扭转历史潮流？

 背景

腹腔镜胆囊切除术是治疗急性胆囊炎的金标准。对于手术风险极高的危重患者，经皮胆囊造口术 (PC) 引流管可替代胆囊切除术。最近，多项研究表明，与腹腔镜胆囊切除术相比，接受 PC 术的患者并发症显着增加。

 方法

我们对 2014 年至 2019 年在我们机构接受 PC 引流或胆囊切除术的患者进行了回顾性分析。我们确定了 PC 使用率并进行了线性回归分析以评估 PC 使用率随时间的变化。 2019 年制定了机构指南并对医生进行了有关 PC 引流正确使用的再教育后，我们将 PC 的使用情况与前几年进行了比较。

 结果

研究期间总共进行了 146 例 PC 和 3163 例胆囊切除术。在胆囊切除术中，754 例 (23.8%) 是在紧急情况下住院的患者中进行的。急性胆囊炎患者中，16.2%接受了PC治疗。线性回归分析表明，2019 年再教育计划结束后，年份与 PC 手术率之间存在显着相关性 ( p <0 id=85>p =0.006)。

 结论

随着 PC 使用率的不断上升，并且最近的研究表明接受该手术的患者的并发症和医疗费用增加，需要注意确保只有合适的患者被转诊接受 PC。机构指南的发布、住院医师和主治外科医生的再教育以及病例审查可以减少不必要的 PC 的放置。