Effective Use of Percutaneous Cholecystostomy in High-Risk Surgical Patients

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Abstract
EMERGENT SURGERY for acute cholecystitis in the elderly has been reported to have a mortality rate as high as 14% to 19%.1,2 In contrast, elective surgery in this same age group has mortality as low as 0.7% to 2%.1,2 General anesthetic risk for patients with significant comorbidities has been determined by the American Society of Anesthesiologists (ASA) classification. Mortality per 1000 patients has been calculated to range from 18.2 to 77.6 for ASA class 3 and 4, respectively.3 Acute acalculous cholecystitis is commonly associated with critical illness, and mortality rates up to 67% have been documented after cholecystectomy.4-6 To lower mortality, Shirai et al7 advocated percutaneous cholecystostomy (PC) as the preferred treatment for acute acalculous cholecystitis. No deaths were reported in 15 patients.