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Objectives <p>The optimal timing of percutaneous cholecystostomy (PC) in moderate-to-severe acute cholecystitis remains uncertain. This study evaluated the relationship between PC timing and clinical outcomes, particularly hospital length of stay (LOS), in patients with Tokyo Grade II–III acute cholecystitis.</p> Methods <p>This retrospective single-center study included 102 patients with Tokyo Grade II–III acute cholecystitis who underwent PC between January 2022 and January 2025. Patients were classified as early (≤24 h), intermediate (25-48 h), or delayed (≥49 h) according to the timing of drainage. Clinical outcomes included LOS, recurrence, in-hospital mortality, hepatopancreatobiliary complications, catheter-related complications, and interval cholecystectomy. Multivariable linear regression analyses using separate ASA-based and Charlson Comorbidity Index (CCI)-based models were performed to identify independent predictors of LOS.</p> Results <p>The mean age was 72.8 years. Sixty-six patients (64.7%) had Tokyo Grade III disease. Mean LOS was 8.76 ± 6.71 days in the early group, 9.45 ± 4.91 days in the intermediate group, and 13.33 ± 9.66 days in delayed group (<i>p</i> = 0.030), with similar findings in both Tokyo Grade II and III subgroups. In multivariable regression analyses, procedural timing remained an independent predictor of LOS in both ASA-based and CCI-based models. Hemoglobin showed a borderline negative association, whereas albumin, Tokyo grade, ASA score, and CCI were not independently associated with LOS. Earlier intervention was also associated with greater white blood cell reduction (<i>p</i> = 0.024).</p> Conclusion <p>Earlier PC was associated with shorter hospitalization and greater early inflammatory improvement. Procedural timing was the most consistent independent predictor of LOS.</p>

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Impact of percutaneous cholecystostomy timing on clinical outcomes in moderate-to-severe acute cholecystitis

  • 期刊论文

  • 发表日期：

    2026年5月9日

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  • Sinan Karatoprak,
  • Mustafa Bilgili,
  • Oğuz Aslan,
  • Gamze Türk,
  • Nur Betül Karatoprak,
  • Uğur Aydemir

摘要

Objectives

The optimal timing of percutaneous cholecystostomy (PC) in moderate-to-severe acute cholecystitis remains uncertain. This study evaluated the relationship between PC timing and clinical outcomes, particularly hospital length of stay (LOS), in patients with Tokyo Grade II–III acute cholecystitis.

Methods

This retrospective single-center study included 102 patients with Tokyo Grade II–III acute cholecystitis who underwent PC between January 2022 and January 2025. Patients were classified as early (≤24 h), intermediate (25-48 h), or delayed (≥49 h) according to the timing of drainage. Clinical outcomes included LOS, recurrence, in-hospital mortality, hepatopancreatobiliary complications, catheter-related complications, and interval cholecystectomy. Multivariable linear regression analyses using separate ASA-based and Charlson Comorbidity Index (CCI)-based models were performed to identify independent predictors of LOS.

Results

The mean age was 72.8 years. Sixty-six patients (64.7%) had Tokyo Grade III disease. Mean LOS was 8.76 ± 6.71 days in the early group, 9.45 ± 4.91 days in the intermediate group, and 13.33 ± 9.66 days in delayed group (p = 0.030), with similar findings in both Tokyo Grade II and III subgroups. In multivariable regression analyses, procedural timing remained an independent predictor of LOS in both ASA-based and CCI-based models. Hemoglobin showed a borderline negative association, whereas albumin, Tokyo grade, ASA score, and CCI were not independently associated with LOS. Earlier intervention was also associated with greater white blood cell reduction (p = 0.024).

Conclusion

Earlier PC was associated with shorter hospitalization and greater early inflammatory improvement. Procedural timing was the most consistent independent predictor of LOS.