Increasing Cholecystostomies: Is this a reflection of COVID, change in indications, or an easy option?

Abstract Background Percutaneous cholecystostomy has been utilized in septic patients with non-malignant biliary pathology who are frail, where surgery is deemed too high risk or conservative management has failed (NICE guidance). The COVID-19 pandemic and the decreased access to surgery may have led to a rise in cholecystostomies. The aim of this study is to evaluate over the last decade, the changing trends, indications, and outcomes of cholecystostomies in our institution. Methods We retrospectively reviewed a prospective database of all patients who had cholecystostomy at our two sites; a Tertiary center and an associated district general hospital, between 2012 and 2022. Exclusion criteria included paediatric patients and biliary malignancies. Patients were grouped as Non-Septic (N-S: cholelithiasis, uncomplicated cholecystitis, choledocholithiasis), and Septic (S: complicated cholecystitis, empyema, systemic sepsis, MODS). Data collected for patient characteristics, co-morbidities using Charlson Co-morbidities Index (CCI), length of stay, duration of cholecystostomy, 90-day morbidity and mortality. Results Cholecystostomies were performed in 150 patients, median age 72 years, 52% female. There was an exponential rise of cholecystostomies over the decade. The overall mortality was 5% (8/150). Patients with CCI score <5 & ³ 5, were compared for mortality (2/98 vs 6/52, p<0.05). The cohort included two groups: N-S (n=105/150, 70%) and S (n=45/150, 30%). All mortalities were in the S group (n=8/45 p<0.001). During COVID interval, there was a rise in non-septic patients getting cholecystostomies, which has persisted post pandemic (figure 1). Cholecystostomies stayed in situ for a median of 76 days (0-830), with subsequent cholecystectomies in 77%. Conclusions There is an exponential rise in the number of cholecystostomies in the last decade, this persisted during and post COVID. The ratio of S: N-S patients getting cholecystostomies was much greater pre-pandemic, then peri- or post-pandemic. The latter may reflect a change in practice. With the increasing pressure of waiting times, need to achieve “hot gallbladders” targets; has cholecystostomy indications changed or does this reflect an easy option and at what cost?