Perkütan kolesistostomi hastalarýnda mortaliteyi ve elektif kolesistektomi kararýný etkileyen faktörler

AMAÇ: Perkütan kolesistostomi akut kolesisti olan yüksek riskli hastalar için bir alternatif veya köprü tedavisi görevi görmektedir. Amacýmýz per-kütan kolesistostomili yüksek riskli hastalarda mortaliteyi tahmin etmek ve elektif kolesistektomi kararýný belirleten parametreleri tespit etmektir. GEREÇ VE YÖNTEM: Akut kolesistit nedeniyle, 2010–2018 yýllarý arasýnda perkutan kolesistostomi iþlemi yapýlmýþ olan 127 hastanýn medical bilgileri geriye dönük olarak toplandý. Kolesistektomi oranlarý ve yüksek riskli hastalarda mortaliteyi belirleyen faktörler analiz edildi. Tanýmlayýcý istatistikler yapýldý. Ayrýca mortalite, elektif kolesistektomi ve albumin için ROC analizi kullanýldý.
BULGULAR: Perkütan kolesistostomi yapýlan 127 hastadan yüksek riskli olanlarýnýn sadece %43.1’ine elektif kolesistektomi yapýldý. Otuz günlük mortalite %11 ve bir yýllýk mortalite %17.3 idi. The American Society of Anesthesiologists (ASA) skoru, Charlson comorbidity index (CCI) skoru, 2018 Tokyo Klavuzu’nda belirlenmiþ olan negatif prediktif faktörlerin varlýðý, American College of Surgeons (ACS) beklenen mortalite yüzdesi ve albümin deðeri; mortaliteyi ve elektif kolesistektomiyi belirlyen anlamlý faktörler olarak bulundu. Albümin deðeri 3.16 mg/dL’den büyük olan hiçbir hastada mortalite izlenmedi ve %82 elektif kolesistektomi oraný elde edildi.
TARTIÞMA: Plazma albümin deðeri, ASA skoru, CCI ve ACS beklenen mortalite yüzdesi mortaliteyi ve elektif kolesistektomiyi kararýný belirlemek için kullanýlabilir. Perkütan kolesistostomi enflamasyonu azaltmak için faydalýdýr ancak hastalarýn medikal komorbiditeleri, nihai durumlarýný belirlemektedir.

Factors affecting interval cholecystectomy and mortality in percutaneous cholecystostomy patients

BACKGROUND: Percutaneous cholecystostomy is an alternative or bridge to cholecystectomy (CCY) in high-risk patients with acute calculous cholecystitis. Our primary aim was to determine the parameters that could be used in interval CCY decision-making and to predict mortality in high-risk patients.
METHODS: The medical records of 127 patients who underwent percutaneous cholecystostomy for acute calculous cholecystitis between 2010 and 2018 were retrospectively analyzed. The primary outcomes were the CCY rate and the factors affecting mortality in high-risk patients. Descriptive statistics and receiver operating characteristic analysis were performed using albumin and elective surgery.
RESULTS: Of the 127 patients undergoing percutaneous cholecystostomy, elective CCY was performed only in 43.1% of the high-risk patients. The 30-day and 1 year mortality rates were 11% and 17.3%, respectively. The American Society of Anesthesiologists’ (ASA) score, Charlson comorbidity index (CCI), the negative predictive factors described in the Tokyo Guidelines 2018, the American College of Surgeons’ (ACS) expected mortality rate, and albumin level were found to be significant factors affecting mortality and elective CCY probability. No mortality was observed, and an 82% elective CCY rate was achieved in patients whose albumin levels were higher than 3.16 mg/dL at initial presentation.
CONCLUSION: The plasma albumin level, ASA score, CCI, and ACS expected mortality rate can be used to predict mortality and decide on elective CCY. Percutaneous cholecystostomy is sufficient for resolving inflammation, but medical comorbidities determine the final condition of patients.