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：是否有可能扭转历史潮流？

背景

腹腔镜胆囊切除术是治疗急性胆囊炎的金标准。经皮胆囊造口术 (PC) 引流是手术风险高得无法接受的危重患者胆囊切除术的替代方法。最近，几项研究表明，与腹腔镜胆囊切除术相比，接受 PC 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 的使用率，并进行了线性回归分析以评估 PC 的使用率。在 2019 年制定机构指南并对医生进行适当使用 PC 引流的再教育后，我们将 PC 的使用情况与往年进行了比较。

结果

在研究期间，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%）是在紧急或紧急情况下在住院患者中进行的。在急性胆囊炎患者中，16.2% 的患者接受了 PC 治疗。线性回归分析表明年份与 PC 手术率之间存在显着关联（p <0.001）。PC 率在 2014 年至 2018 年期间从 13.8% 上升到 22.5%，并在再教育计划后下降到 2019 年的 10.9%（p = 0.006）。

结论

随着 PC 使用率的上升以及最近的研究表明接受此手术的患者的并发症和医疗保健成本增加，需要注意确保只有合适的患者被转介进行 PC。发布机构指南、住院医师和主治医师再教育以及病例审查可以减少不必要的 PC 的放置。