The following is a summary of “Non-operative management of cirrhotic patients with acute calculous cholecystitis: How effective is it?,” published in the November 2023 issue of Surgery by Hanna et al.

The management approach for acute calculous cholecystitis (ACC) in patients with cirrhosis has been an area of investigation. 

Researchers performed a retrospective study investigating the outcomes of cirrhotic patients with ACC who underwent cholecystectomy versus those managed with nonoperative management (NOM).

They analyzed the  Nationwide Readmissions Database ( 2017), which focused on cirrhotic patients diagnosed with ACC. Patients were categorized into three groups based on their management approach, cholecystectomy, percutaneous cholecystostomy (PCT), and antibiotics-only treatment. The primary outcomes assessed were complications and the failure rate of NOM. Secondary outcomes such as mortality rates, length of hospital stay (LOS), and associated charges were also evaluated.

The results showed that for 3,454 patients, the breakdown based on treatment was that 1,832 patients underwent cholecystectomy, 360 received PCT, and 1,262 were treated solely with antibiotics. Mortality rates varied significantly among the groups, with PCT patients recording the highest mortality at 16.9%, followed by the antibiotics-only group at 10.9% and the cholecystectomy group at 4.2%. PCT-treated patients had a longer LOS but lower charges than those undergoing surgery. Notably, the failure rate of NOM was observed to be 28.2%. Regression analyses highlighted PCT as a significant predictor associated with increased mortality.

They concluded that ACC in cirrhosis patients is grim: 1 in 3 fail non-operative treatment, face longer hospital stays, and have higher mortality

Source: americanjournalofsurgery.com/article/S0002-9610(23)00328-8/fulltext