Factors Affecting Cholecystostomy Tube Removal and Interval Cholecystectomy Timing After Percutaneous Cholecystostomy for Acute Cholecystitis
Abstract
Background:
Percutaneous cholecystostomy (PC) is widely used. It is used in high-risk patients with acute cholecystitis. These patients are not suitable for immediate surgery. However, the optimal timing for removing the cholecystostomy tube and performing subsequent interval cholecystectomy (IC) remains controversial. This study aimed to evaluate factors affecting PC tube removal time and IC timing, and to identify predictors associated with operative outcomes.
Methods:
This retrospective, single-centre study included patients who underwent percutaneous cholecystostomy for acute cholecystitis between 2015 and 2025. The following data were analysed: demographic characteristics, comorbidity burden, American Society of Anesthesiologists (ASA) scores, Tokyo 2018 acute cholecystitis grade, gallbladder perforation, operative status, surgical approach and mortality. Factors associated with cholecystostomy tube removal time and IC timing were evaluated using comparative and regression analyses.
Results:
A total of 102 patients were included in the study, with an average age of 64.4 ± 15.4 years. Interval cholecystectomy was performed in 71 patients (69.6%), while 31 patients (30.4%) were managed non-operatively. Patients who underwent surgery were significantly younger and had lower ASA scores and Charlson Comorbidity Index values compared with those who did not undergo surgery (p<0.05 for all). The mean cholecystostomy tube removal time was 38.1 ± 20.4 days. The timing of tube removal was not significantly associated with sex, calculous cholecystitis, gallbladder perforation, operative approach or conversion to open surgery. Similarly, the timing of the interval cholecystectomy did not have a significant effect on either the operative approach or the conversion rates. Patients with acalculous cholecystitis had a significantly longer interval to surgery (p = 0.034). Mortality was significantly higher in non-operated patients (25.8% vs. 1.4%, p < 0.001). Increased mortality was associated with advanced age, a higher ASA score and gallbladder perforation. No perioperative or postoperative bile duct injury was observed.
Conclusion
Percutaneous cholecystostomy remains an effective strategy for managing high-risk patients with acute cholecystitis. In this cohort, cholecystostomy tube removal time and interval cholecystectomy timing were not associated with surgical approach or conversion outcomes. Surgical decision-making appears to be driven primarily by patient-related factors such as age, comorbidity burden and clinical status rather than a fixed procedural timeline. Therefore, individualised timing strategies may be more appropriate than strict interval-based approaches following percutaneous cholecystostomy.
Keywords
Acute cholecystitis, Percutaneous cholecystostomy, Interval cholecystectomy, Cholecystostomy tube, Surgical timing
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