P-BN06 Percutaneous cholecystostomy rates are increased following COVID-19 induced disruption to elective surgical pathways

Abstract Background The COVID-19 pandemic has led to major service disruptions, including the cessation of elective laparoscopic cholecystectomies (LC), causing delays in managing symptomatic gallstones. We hypothesised that this would lead to an increased need for percutaneous cholecystostomy (PC) for acute cholecystitis. Methods We performed a retrospective cohort study in a single NHS trust. We included all patients who underwent either LC or PC during the periods of March 1st – August 31st over the years 2019 and 2020. Patient data was obtained from prospectively maintained patient electronic notes. Data are presented as median and interquartile ranges for continuous data and the percentages for categorical data and compared with Mann-Whitney U-test and Fisher’s exact tests respectively. Results We observed a substantial reduction in the number of LC performed in 2020 (n = 99) compared to 2019 (n = 198), whilst the number of PC performed in 2020 (n = 35) was more than double that in 2019 (n = 17) (Fig.1). This increase in numbers persisted even after our LC service was restarted. Comparing the patients who underwent PC in both years, there were no significant differences in age (2019: 68 (45-76) vs 2020: 72 (57-81), p = 0.41), comorbidities (Charlson comorbidity index≥4: 10 (59%) vs 16 (46%), p = 0.56), or in-hospital mortality (2019: 2 (12%) vs 2020: 3 (9%), p = 0.99). As a proportion of all biliary interventions for cholelithiasis, PC increased from 8% (17/214) in 2019 to 26% (35/134) in 2020 (p < 0.001). Conclusions These results show how the cessation of LC service was directly related to increased numbers of invasive ‘damage control’ procedures for acute cholecystitis, emphasising the importance of maintaining COVID-secure surgical pathways. The numbers of PC remained high even after the restart of LC service, consistent with a ‘COVID shadow’ resulting from interruptions to elective services that impacts patient care for a prolonged period.

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Cholecystostomy as Bridge to Surgery and as Definitive Treatment or Acute Cholecystectomy in Patients with Acute Cholecystitis

Gastroenterology Research and Practice ◽

10.1155/2016/3672416 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Agnieszka Popowicz ◽

Lars Lundell ◽

Peter Gerber ◽

Ulf Gustafsson ◽

Emil Pieniowski ◽

...

Keyword(s):

Standard Deviation ◽

Hospital Stay ◽

Acute Cholecystitis ◽

Medical Records ◽

Definitive Treatment ◽

Bridge To Surgery ◽

Percutaneous Cholecystostomy ◽

Stockholm County ◽

Number Of Patients ◽

Comorbidity Index

Purpose.Percutaneous cholecystostomy (PC) has increasingly been used as bridge to surgery as well as sole treatment for patients with acute cholecystitis (AC). The aim of the study was to assess the outcome after PC compared to acute cholecystectomy in patients with AC.Methods.A review of medical records was performed on all patients residing in Stockholm County treated for AC in the years 2003 and 2008.Results.In 2003 and 2008 altogether 799 and 833 patients were admitted for AC. The number of patients treated with PC was 21/799 (2.6%) in 2003 and 50/833 (6.0%) in 2008. The complication rate (Clavien-Dindo ≥ 2) was 4/71 (5.6%) after PC and 135/736 (18.3%) after acute cholecystectomy. Mean (standard deviation) hospital stay was 11.4 (10.5) days for patients treated with PC and 5.1 (4.3) days for patients undergoing acute cholecystectomy. After adjusting for age, gender, Charlson comorbidity index, and degree of cholecystitis, the hospital stay was significantly longer for patients treated with PC than for those undergoing acute cholecystectomy (P<0.001) but the risk for intervention-related complications was found to be significantly lower (P=0.001) in the PC group.Conclusion.PC can be performed with few serious complications, albeit with a longer hospital stay.

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Acute Cholecystitis and the Controversies of Treatment

Journal of the Nuffield Department of Surgical Sciences ◽

10.37707/jnds.v1i1.52 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Jessica Prince ◽

Daniel Hancu

Keyword(s):

Acute Cholecystitis ◽

Symptom Control ◽

Percutaneous Cholecystostomy ◽

Tokyo Guidelines ◽

Delayed Cholecystectomy ◽

Control Hospital ◽

Symptomatic Gallstones ◽

Bail Out ◽

Learning Points ◽

Difficult Cases

Key Learning Points: 1. Acute cholecystitis is often a complication of gallstones disease 2. Most of patients with symptomatic gallstones disease are prone to further complications and cholecystectomy is indicated 3. Laparoscopic early cholecystectomy in acute cholecystitis is superior to delayed cholecystectomy in terms of symptom control, hospital stay and re-admissions, with similar morbidity and mortality and should be attempted in all cases of acute cholecystitis. Difficult cases should be managed by experienced surgeons, in advanced centers, and bail-out procedures should be attempted as per Tokyo guidelines. 4. Percutaneous cholecystostomy should only be used in patients unfit for surgery who fail to improve 5. The data available to support optimal antibiotical treatment is scarce, and local microbiology guidelines should be used.

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